PLEASE CHECK THE FOLLOWING

New Marine Membership $30.00

Membership Renewal $25.00

I hereby certify I have served as a U.S. Marine for more than 90 days, that the character of my service has been honorable, and if discharged, I am in receipt of an honorable discharge. I hereby agree to provide proof of honorable discharge/service upon request.

Name:

Address:

City: State/Prov:

Country: Zip/Post:

Phone:

Email:

Date of Birth: Date of Discharge:

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