Membership Application

Jayhawk Chapter, The Retired Officers Association

___ Enroll me as a new regular member

___ Enroll me as a new auxiliary membe

PLEASE PRINT (See * below for surviving spouse)

Last Name

First

Middle

Rank

Street Address

Apt #

Phone

City

State

Zip +4

* Name of Deceased Officer

Rank

 

PLEASE CHECK APPROPRIATE BOXES:

 

Member of National TROA? ___ Yes___ No

___ Army

___ USA (Regular)

If yes, your card number please ________________

 

___ AUS (Reserve/Nat'l Guard)

 

 

___ Navy

___ USN (Regular)

 

 

 

___ USNR (Reserve)

___ Male

___ Active Officer

___ Air Force

___ USAF (Regular)

 

 

 

___ USAFR (Reserve)

___ Female

___ Retired Officer

___ Marine Corps

___ USMC (Regular)

 

 

 

___ USMC (Reserve)

 

___ Former Officer

___ Coast Guard

___ USCG (Regular)

 

 

 

___ USCG (Reserve)

 

 

___ Public Heath Svc

 

 

 

___ NOAA

 

 

Signature: __________________________________________ Date: ______________________

 

Annual Dues, payable 1 January, are $15.00 for a regular member and $5.00 for an auxiliary member.

Mail check and application to: Jayhawk Chapter, TROA

C/o Jeffery O. Heeb, Secretary - P.O. Box 485, Lawrence, Kansas 66044-0485