TODAY’S DATE:____________________________ Amount remitted herewith: $______________
NAME______________________________________SEX______ PHONE______________________________
MAIL ADDRESS____________________________________________________________________________
_____________________________FAX_________________________EMAIL__________________________
Check appropriate: Married ___ Widowed ___ Single ___ Working ___ Retired ___ Semi-Retired ___
Worked for Stripes? _____ If yes, Which edition(s)?______________________ Dates___________________
If yes, what did you do?_______________________________________________________________________
Military, Civilian, both? Details: _______________________________________________________________
What did you do before Stripes? ____________________________________________ __________________
What did you do after and what are you now doing?________________________________________________
_________________________________________ _____________________________________ ___________
If never with Stripes, what, if any, is your connection with Stripes? (Friend, supporter, etc.)_____________
____________________________. Living spouse’s first name ____________________ Children’s names,
occupations, locations: _______________________________________________________________________
# of grandchildren ___ # of great-grandchildren____
Dues are payable each January. The dues you remit now may be pro-rated. The Association
is non-profit,
but dues and donations are not tax-deductible. Donations to the
Museum/Library Association are tax-deductible.
Please make your check
payable to: Stars and Stripes Assn., Inc.
Mail with this form to:
Additional info you may wish to add: