LIFE MEMBERSHIP APPLICATION SAN MIGUEL BRANCH 367
I wish to apply for Life Membership in the FRA. I hereby certify that I am eligible. I fully understand the provisions of the "Life
Membership Program".
NAME: _______________________________________________________________RATE / RANK: ______________
CURRENT FRA MEMBERSHIP NO: _____________________________
ADDRESS: ______________________________________________________________________________________
PHONE: ( ) ____________________DOB: __________________BRANCH NO: ___________
SSN: _____________________ SERVICE: ___________ STATUS: _____________
SPOUSE'S NAME: ____________________________________________________
YOUR E-MAIL ADDRESS: ________________________________________________________________________
RECRUITED BY: ________________________________________________________________________________
MEMBER NO: ______________________________BRANCH NO: ___________________________
APPLICANT'S SIGNATURE: ______________________________________________________________________
DATE: ___________________
FRA dues are not tax deductible as charitable contribution for federal income tax purposes. However, they may be tax deductible under other
provisions of the Internal Revenue Code. Life Membership dues include a $7.00 subscription to Naval Affairs.
Lifetime Membership Allotment (circle) 1 year 2 years Eff. Date _____________________________
Month Year
PAYMENT OPTIONS (CIRCLE) : M.C. VISA DISCOVER AMER. EXP. CHECK OR
MONEY ORDER
AMOUNT: _______________________________CREDIT CARD NO: ______________________________________
EXP. DATE: _____________________SIGNATURE: _____________________________________________________
