Application

Name *

Personal Email Address *Do not use a military or government email address

Phone *

Date of Birth *

Street Address

Apartment, suite, etc

City

State

ZIP / Postal Code

Country

Time Served with the 193rd *

Total Time Served *

Last Squadron Assigned *

Highest Rank Held

Status *RetiredCurrent 193 MemberFormer Member

Date Retired if Retired

Type Membership

Note

Membership shall run from 1 January to 31 December. Dues paid after 1 October will be applied to the next year.

Annual Membership $15.00. Lifetime Membership (to determine your dues, subtract your age from 100 and multiply that by three)

Membership Type *AnnualLife

How will you pay? *CashCheckPay Pal

Currency *

USD

If paying for a lifetime membership please enter the amount you will be paying

Payment Information

If paying by cash or check please mail to:

193rd SOW Association 81 Constellation Court #14 Middletown, Pa 17057

You can pay online by using the Send feature at this link: https://www.paypal.com/paypalme/193SOW