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Name (Print): ______________________ Resident Address: _____________________________ City: _________________ State: ____ Zip: _____ Tel No: ____________ Date of Birth: _______ Occupation: _______________________ Spouse’s First Name: _________ - - - - - Military Service - - - - - Branch of Service: _____________________________ Honorable Discharge (Yes or No) ______ Serial Number: ______________ Active Duty Date:____________ Release Date: _____________
Please attach a copy of your DD214 and a check in the amount of $25.00 payable to Post 56 ITAM and mail with this application to: Dues Officer, C/O Post 56, 143 Brimbal Ave., Beverly, MA 01915 - - - - - For Committee use only - - - - - Received by:: ______________________ Rec'd date: __________________ Check # ______ Approved/Disapproved : ________ Remarks:_______________________________________ ITAM # assigned: _____ ITAM Card # assigned: _____Date issued: ____________Rev 03/09 |