Membership Form in PDF

Dues & Membership Form
Print and send to	Wayne Reece P. O. Box 1109 Carlton, OR 97111
Make check payble to: 92nd USAAF-USAF Memorial Association

Name: ___________________________________

Address: _________________________________   Wife's First Name: _________________

_________________________________________

City: ________________________	State: ________________	Zip: ___________-________
		9 digits on the zip code please

92nd Unit/s _________________  Specialty: __________________________________

Dates Assigned: ______________________________

POW Capture Data

Date ____________________

Place ___________________

Stalag Luft # _____________ (if WWII)

Dues $20.00/year ________

Memorial Contribution

$______________  For: ___________________________________________________

Total Enclosed: $ _______________