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 |
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Street Address |
Apt # |
Phone |
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City |
State |
Zip +4 |
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* Name of Deceased Officer |
Rank |
PLEASE CHECK APPROPRIATE BOXES:
Member of National TROA? ___ Yes___ No |
___ Army |
___ USA (Regular) |
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If yes, your card number please ________________ |
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___ AUS (Reserve/Nat'l Guard) |
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___ Navy |
___ USN (Regular) |
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___ USNR (Reserve) |
___ Male |
___ Active Officer |
___ Air Force |
___ USAF (Regular) |
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___ USAFR (Reserve) |
___ Female |
___ Retired Officer |
___ Marine Corps |
___ USMC (Regular) |
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___ USMC (Reserve) |
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___ Former Officer |
___ Coast Guard |
___ USCG (Regular) |
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___ USCG (Reserve) |
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___ Public Heath Svc |
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___ NOAA |
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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