*Last Name _________­­_________ First Name _________________ Middle Initial _____

 *Service (Circle One):  USA    USN   USAF    USMC     USCG   USPHS   NOAA

 *Status (Circle One):  Active Duty      Inactive/Reserve      Retired

 *Highest Rank_______________Retired at Rank (Circle One): YES      NO

 *Street Address: ___________________________Congressional Dist:_______________

 *City: ____________________________ State: __________ Zip: __________ - _________

 *Home Phone: ____-_____-________      Email: __________________________________

 *Service Dates: From ___________        To: ______________
 

* War Veteran Status (Circle All That Apply): WWII-Africa, WWII-Europe, WWII-Asia, Korea,  
   Gulf-SW Asia, Vietnam, Iraq/Afghanistan, (GWOT)   Other _______________

 *Spouse’s Name: __________________________

 Additional Spouse Interests: __________________________________________________

*MOAA (Formerly TROA) Member (Circle One)  YES    NO         If YES, MOAA Number

     (2^nd Line on A  Military Officer  Magazine Mailing Label): ________________________ 

Is Applicant “Life Member” of MOAA? (Circle One)  YES   NO 

If employed, current position: ______________________________ (If available, please attach a copy of your business card to the application)

Employer Name: ___________________________City/State: ________________/_______ 

SIGNATURE: ___________________________________ DATE: _____________________

Mail Application  to:
VP-Membership
P.O. Box 7692 Inwood Station
Dallas, TX 75209-0692

Your 2010 MOAA-GDC Membership is free. 2011 annual dues are due 1 November 2010.

* = required