(Please Print All Entries Clearly)

Visa [ ] Mastercard [ ] Check Enclosed [ ] Money Order Enclosed [ ]

Type of Application – New [ ] Renewal [ ] Member # _________________________

Name as it appears on card: _____________________ Credit Card # ______________________

Send Membership Card and Info to:

Name:______________________________________________________________________

Address: ____________________________________________________________________

Address: ____________________________________________________________________

City: ____________________________ State/Province: ______________________________

Zip/Postal Code: __________________ Country: ____________________________________

Your Phone: _____________________ Your E-mal: _________________________________

Date Of Birth: _____/_____/_____ Date of Enlistment/Commissioning: ____/____/____

Date of Discharge/Seperation/Retirement: ____/____/____ Service # ____________________

I hereby enclose $25.00 for one years membership in the Marine Corps League as:

[ ] Member-at-large (no detachment afflilation)

[ x ] Detachment if known: * Cpl. Mason O. Yarbrough Detachment #1081

All Memberships include 1-year subscription to Marine Corps League Magazine

I hereby certify that 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 an honorable discharge. By signature on this application, I hereby agree to provide proof of honorable discharge/service upon request.

_________________________________________

Applicant’s Signature

_________________________________________

Sponsor- Where Applicable

*This Form may be completed and submitted to any local community-based Detachment of the Marine Corps League, if known, however, detachments reserve the right to set rates of dues as determined by the local mambership