Regular Membership Application



I hereby certify I have served as a U.S. Marine for more than 90 days, that the character of my service has been honorable, and if discharged, I am in receipt of a discharge other than Dishonorable. By selecting 'Yes' herein, I hereby agree to provide proof of my serivce and discharge.
Yes No


Full Name:
Address:
City/State/Zip:
Phone:
Date of Birth(mm/dd/yyyy):
Date Entered Service(mm/yyyy):
Email:
Today's Date(mm/dd/yyyy):





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