BECOME A LIFE MEMBER OF THE FLEET RESERVE ASSOCIATION TODAY!

1. Print this page.         2. Fill out the form.         3. Mail completed form with payment to:

                               
        FLEET RESERVE ASSOCIATION
                                       125-N. WEST STREET
                                       ALEXANDRIA, VA. 22314-2754

                           Make Checks and Money Orders payable to the:

                                       FLEET RESERVE ASSOCIATION
              
                         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: _____________________________________________________
Thank you, SHIPMATE, for joining San Miguel Branch 367 as a LIFE MEMBER! Send
us an e-mail to let us know you've chosen Branch 367 as your home!
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