GIVE ME TEN - 2008 (Membership in the National Organization)
Military Officers Association
of America (MOAA)
MEMBERSHIP ENROLLMENT FORM
Name: _____________________________________
Branch of Service: ______________ Rank: _______
[ ] Retired [ ]
Active Duty [ ] Former
(Veteran)
[ ] Reserve [ ] National
Guard [ ] Auxiliary (Surviving spouse of eligible officer)
Address:
_______________________________________
City:
________________________ State:____ Zip:________
Date of Birth: DD_____MM ________YYYY:_____
Spouse Name:
____________
Phone Number: ( )
_____________________ Spouse DOB: _____________
Email Address: _________________________
(MOAA will send email, but
will not release nor sell your email address nor other contact info to
third parties).
Signature:
____________________________________ Date____________
(Signature not required for free, emailed memberships).
Recruiting Chapter: Virginia
Peninsula VIPMOAA email VIPMOAA@cox.net
Recruiter: _____________________________(VIPMOAA Member)
If none entered, use Give
Me Ten recruiter Major Melva Mallison (757) 596-5536
There are MOAA prizes and drawings for
recruiters, recruiting chapters and recruits.
[ ] Free for ACTIVE DUTY,
GUARD & RESERVE OFFICERS
Note:
ROTC and Junior ROTC Instructors may also receive membership with Give
Me Ten
FOR NEW MEMBERSHIPS
ONLY - NOT RENEWING MOAA MEMBERS.
Since no payment is
required, you may email form content to VIPMOAA@cox.net (indicate "Give Me
Ten" in the subject line), or mail to VIPMOAA at the address below.
[ ] OTHERS PAY $25 for two years:
New memberships only - not renewing MOAA members.
Make your check payable to
MOAA. Mail to VIPMOAA at the address below.
[
] LIFE MEMBERSHIP. Even current MOAA
members may convert to life membership, and still count toward
Give Me Ten incentives. (Note: Life membership rates are
listed separately and to review them click here).
Check Payable to "MOAA". Mail to VIPMOAA
MAIL TO: VIPMOAA- Give Me Ten Box 4305 Fort Eustis VA 23604
Dues to MOAA are not deductible as charitable
contributions for federal tax purposes. Annual membership dues
include a $12 subscription to MILITARY OFFICER Magazine.