MILITARY OFFICERS ASSOCIATION OF
CITRUS
Application For Membership
Full Name (Last,
First, Middle):____________________________________________
Nickname if preferred:____________________________________________________
Rank: _________________ Service: ____________________Retired(Y/N):
_______
Regular Officer or
Reserve?______________
Gender:__________________________
Name Prefix (Mr, Mrs,
Ms, Dr)____________ Name Suffix (Jr,
III):______________
Address: _______________________________________________________________
City:
Telephone:_________________E-Mail Address:_______________________________
Spouse’s Full Name
and Nickname:_________________________________________
If you are a National
Guard member, please write your component:______________
PLEASE CHECK ONE BELOW:
( ) REGULAR MEMBERSHIP (Retired, active duty or former Officer,
Warrant Officer, Limited Duty Officer of the United States Army, Navy, Air
Force, Marine Corps, Coast Guard, NOAA or Public Health Services)
( ) AUXILIARY MEMBERSHIP (Widow or widower
of a deceased person who would, if still living, be eligible for membership)
Deceased
Spouse’s Name________________________________
Deceased
Spouse Rank and Service_______________________
Applicant’s
Signature_____________________________________________________
National MOAA
Number*_________________________________________________
Annual Dues
Regular Member $15.00 Chapter $25.00 National*
Auxiliary Member $ 6.00 Chapter $19.00 National*
* Note: You must be a National member of MOAA to belong to our local
chapter. If you are not a National
member, check here ( ), and we will send
a copy of this application to MOAA National.
If you are a new member, there is a new national member discount of two
years for 25.00.
Send this completed
form to: MOAA of
(Or better, scan it
and send Post Office Box 995
via the e-mail address below)
If you have any questions, please contact our secretary, Gary E Runyon
at:
(352) 563-5727 or e-mail him at laserger@infionline.net