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MILITARY OFFICERS
ASSOCIATION OF AMERICA
CITRUS COUNTY CHAPTER
Application For Membership
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Full Name (Last, First, Middle)
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Nickname if preferred
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Retired(Y/N
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SERVICE
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RANK
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Regular Officer or Reserve?
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Gender:
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Name Prefix (Mr, Mrs, Ms, Dr)
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Name Suffix (Jr, III
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Address:
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ZIP
9 digits if
possible
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State
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City:
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E-Mail Address
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Telephone
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Spouse’s Full Name and Nickname:
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If you are a National Guard member, please write your component:
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PLEASE CHECK ONE BELOW
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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)
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AUXILIARY MEMBERSHIP (Widow or widower of a deceased person
who would, if still living, be eligible for membership)
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Deceased Spouse
Rank and Service
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Deceased Spouse’s Name
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National MOAA Number*
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Annual Dues
Regular Member $15.00 Chapter $25.00 National (new members get first 2yrs for 25.00)
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, click on the link to the right and join.
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Join MOAA
national
(click here)
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If you have any questions, please contact our
secretary, Gary E Runyon at:
(352) 563-5727 or e-mail him at
laserger@infionline.net
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