NAME: ____________________________________________________

ADDRESS: _________________________________________________

CITY: ____________________ STATE: ___________ ZIP: __________

TELEPHONE: _____________ EMAIL: _________________________

AGE:_____________ SPOUSE’S NAME:_________________________

ORGANIZATION: ___________________ YEARS:________________

MEMBERSHIP DUES:

___	ANNUAL: REGULAR	$15.00
___	ASSOCIATE	$10.00
	LIFE:
___	Less than 45 years	$175.00
___	45 - 64 Years	$150.00
___	65 years and older	$125.00

___________________________	________________
Signature	Date

Please send completed application and a check in the amount indicated above to:

366th Fighter Group Association
ATTN: Membership
10415 226th Place
Edmunds, WA 98020-5124

Membership # ____________

Application # 6-[an error occurred while processing this directive]