Chapter Membership Application

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="04e285a1erlcgo.gif"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>The Hilton Head Area Chapter-MOAA</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="The Hilton Head Area ChapterMOAA"><U><B>home</B></U></A></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="The Hilton Head Area ChapterMOAA"><U>The Hilton Head Area Chapter-MOAA</U></A>   |   <B>Chapter Membership Application</B>   |   <A HREF="id17.htm" TARGET="_top" TITLE="2011 Programs"><U>2011 Programs</U></A>   |   <A HREF="id79.htm" TARGET="_top" TITLE="NEXT EVENT ANNOUNCEMENT AND RESERVATION "><U>NEXT EVENT ANNOUNCEMENT AND RESERVATION FORM</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="04dd2c00dkelyh.gif"> <div> CHAPTER MEMBERSHIP APPLICATION</div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <bR> <div> HILTON HEAD AREA CHAPTER</div> <div> The Military Officer's Association America</div> <div> Post Office Box 22631</div> <div> Hilton Head Island, South Carolina  Postal  29925</div> <bR> <bR> <bR> <bR> <div> <I>MEMBERSHIP APPLICATION</I></div> <bR> <div> <B>Date:    _____________________</B></div> <bR> <bR> <div> <B>Name:  _____________________  </B></div> <bR> <bR> <bR> <div> <B>    _____________________      __________</B></div> <div> <B>               Last                         First                  M.I.</B></div> <bR> <bR> <div> <B>Spouse: </B></div> <div> <B>   ________________________________________________________</B></div> <bR> <div> <B>Rank and Service:  </B></div> <bR> <div> <B>  _______________________________________________</B></div> <bR> <bR> <div> <B>Address:   </B></div> <div> <B>   ______________________________________________________</B></div> <div> <B>                              Street</B></div> <bR> <div> <B>             __________________</B></div> <div> <B>                         City                              Zip</B></div> <bR> <div> <B>Telephone _________________________________</B></div> <bR> <div> <B>Email:</B> <FONT SIZE="3" COLOR="#000000" FACE="Arial" >   ___________________________________</FONT></div> <bR> <div> <B>Date of Birth:    _____________________________</B></div> <bR> <div> <B>Plantation:      </B></div> <bR> <bR> <div> <B>____________________________________________________</B></div> <bR> <div> <B>Member of National MOAA?          Yes    ___       No    _______</B></div> <bR> <div> <B>Sponsor (Optional):  </B></div> <bR> <bR> <div> <B>  _____________________________________________</B></div> <bR> <bR> <div> <B>Dues: ($20 annually)   Please Pay with Application</B></div> <bR> <bR> <bR> <div> <B>                                  ________     _______________________</B></div> <div> <B>                                             Signature</B></div> <bR> </td> </tr></table></body>