Membership Application

First Name

_________________________ Middle Initial ________

Last Name

_________________________________________________

Date of Birth (M/D/Y)

_______/_______/_______

Address

__________________________________________________

City, State, Zipcode

__________________________________________________

Phone Number

(_______)________________________

YES! I’ll help my fellow veterans by becoming a member of The American Legion. I certify by forwarding this application that I served at least one day of active military duty during the dates marked below and was honorably discharged or am still serving honorably. I have enclosed a check/money order or charge my credit card $________ for annual membership dues in Indiana American Legion Post ______________.

All fields must be completed and application must be typed or printed neatly. Thank You.

Branch of Service
US ARMY
US AIR FORCE
US COAST GUARD
US MARINE CORPS
US MERCHANT MARINE 12/41-8/45
US NAVY

Dates of Service
Aug 2,1990 - Open
Dec 20,1989 - Jan 31,1990
Aug 24,1982 - July 31,1984
Feb 28,1961 - May 7,1975
June 25,1950 - Jan 31,1955
Apr 6,1917 - Nov 11,1918

	Credit Card Type		VISA MASTERCARD DISCOVER
	Credit Card Number		________-________-________-_______
	Exp Date (MM/YYYY)		_______/_______
	Amount		$_________

A portion of the annual dues ($3.00) is allocated to The American Legion Magazine for a 12-month subscription; it is non-refundable and non-deductible from dues.

Please Mail Payment to: American Legion Post ___ ______

Address:_______________________________________ Contact: _______________________________

________________________________________________ Phone: (_______)________________________