On-Line MOAA SOMD Chapter Membership Application

Please provide the following contact information those items with an asterisk are mandatory:

*First name
*Middle Initial
*Last name
National MOAA # (if applicable)
Social Security Number- Optional
Birth Date- Optional
*Spouse's name
*Rank
*Service
	* Active Duty * Retired * Former * Reserve * National Guard *Surviving Spouse of Eligible Officer
*Preferred Street address(usually home address where we will send announcements)
*Address (cont.)
*City
*State/Province	Use the two letter abbreviation please
*Zip/Postal code
Contact Phone (Work):
*Contact Phone (Home):
*E-mail
*Date of Application

Please mail a check for $20.00 to the address below:

Military Officers Association of America-Southern Maryland Chapter P.O. Box 84 NAS Patuxent River, MD 20670

Please review the form for accuracy before pressing the Submit Form button.   When you submit this form, the data on this form will be sent to Tom Smith, Vice President for Membership via email.  If you have any questions, please follow up with Tom.  His contact information is available by clicking here.

Thanks