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| WOMEN MARINES ASSOCIATION Check Applicable box: New Renewal Reinstate Life Information Update Annual 1yr $15 2yr $25 Life 30&Under $220 31-45 $190 46-60 $155 61&Over $120 Dates served to Platoon MOS(s) Name Last First MI Last Name Used On Ac/Res duty Address Street Street City State ZipSSN DOB Chapter Code Phone Next of Kin Relationship Address Phone Your Email Address Please add to the WMA online Communication list.
Signature ________________________________________ Date Enrolled/Referred by: M. Merritt I certify, by my signature, that I am now serving or have served honorably in the United States Marine Corps, regular or reserve components.
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