Charleston
Chapter MOAA
Membership Application Form
Category(circle one): New Member
Renewal Change of Address
Chapter Dues: $10.00 a year for Regular membership. $5.00 a year for Auxiliary
membership.
Multiple year dues are encour-aged in order to reduce paperwork.
Last Name:_________________________
First Name:_____________________ MI:_____
Rank: ______________
Service: ___________ Spouse's Name:______________________
Address: __________________________________________________
City:______________________________ State: _____ Zip: __________
Phone Number:_______________________ Email:______________________
If you are a member of National MOAA, please provide your membership number:
Your status (circle one)
Retired Active Duty Reserve
National Guard Former Officer
Auxiliary
Dues for Year (s) _______________ Amount enclosed:____________________
Signature____________________________________
Please make check
or money order to, and return completed form with check or money order (please,
no cash) to:
Charleston MOAA
P.O. Box 70421
Charleston, SC 29415-0421