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SAMPSON AIR FORCE BASE VETERANS ASSOCIATION Inc.
(Recognized by the Pentagon and the National Museum of the Air Force)

MEMBERSHIP APPLICATION

PLEASE CHECK WHICH TYPE OF MEMBERSHIP YOU ARE APPLYING FOR


ACTIVE= INDIVIDUALS (CIVILIAN OR MILITARY) WHO SERVED AT SAMPSON AFB, GENEVA, NY


HEREDITARY= SPOUSES, ADULT CHILDREN, OTHER BLOOD RELATIVES OF ACTIVE LIVING OR
DECEASED MEMBERS


ASSOCIATE
= INDIVIDUALS, BUSINESSES OR ORGANIZATIONS WHO ACTIVELY CONTRIBUTE TOWARD

ACHIEVEMENT OF ASSOCIATIONS GOALS.


DUES

ANNUAL MEMBERSHIP = $20 PER YEAR

*PERSONAL INFORMATION: (PLEASE PRINT)......................................DATE……………........................………

FIRST NAME: .................................................... MI: ............... LAST NAME: ...............................................................................

STREET ADDRESS: .........................................................................................................................................................................

CITY/TOWN: ......................................................................................... STATE: ................... ZIP: ................................................

PHONE #: ............................................................................... CELL PHONE #: .............................................................................

NICK NAME: ….............................. SPOUSES NAME: ...................................... SPOUSES NICK NAME: ................................

E-MAIL ADDRESS: ..........................................................................................................................................................................

*MILITARY INFORMATION

FLIGHT #............................................................ YOUR SERIAL #..............................................................................

DATES @ SAMPSON

FROM: ..................................... TO: ................................... SQDN: .................................. GROUP: ............................

BARRACKS: ....................... AREA: …............... DI/TI (S) NAME & RANK:...................................................

*MISC. INFORMATION:

HOME TOWN WHEN YOU JOINED USAF

CITY/TOWN: .......................................................................................... STATE: ..........................

HOW DID YOU LEARN ABOUT THE ASSOCIATION? .............................................................................

…………………………………………………………………………………………………………………...

DO YOU HAVE PICTURES, ORDERS, OTHER DOCUMENTS OR ITEMS FROM YOUR TIME @ SAMPSON? YES NO

PLEASE USE THE REVERSE SIDE TO LIST YOUR ASSIGNMENTS WHILE AT SAMPSON AND AFTER SAMPSON

PLEASE MAKE CHECK PAYABLE TO: SAMPSON AFB VETERANS ASSOCIATION, Inc

SEND THIS APPLICATION AND PAYMENT TO:

SAMPSON AFB VETERANS ASSOCIATION, Inc

P.O. BOX 1612

N. MASSAPEQUA, N.Y. 11758-0911

SAFBVA S-Doc # 22 6/13/13