Marine Corps Mustang Association Membership Application

Marine Corps Mustang Association, Inc. - Membership Application

To apply for membership please complete all questions.
Name of Applicant *

First Name Last Name
Spouse Name *
Rank *
MOS *
Place of Birth
Date of Birth *

Month Day Year
Date
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
E-mail
Current Status *

USMC USMC (Ret) USMCR USMCR (Ret) FMCR Marine Veteran Other
Enlisted Highest Rank Held
Warrant Highest Rank Held
Commissioned Highest Rank Held
Services Other than USMC (Enlisted / Officer)
Dates of Reserve Service

Month Day Year
Date
Dates of Reserve Service
MM/DD/YYYY - MM/DD/YYYY
Dates of Warrant Service Start

Month Day Year
Date
Dates of Warrant Service
MM/DD/YYYY - MM/DD/YYYY
Dates of Enlisted Service
MM/DD/YYYY - MM/DD/YYYY
Dates of Commissioned Service
MM/DD/YYYY - MM/DD/YYYY
Work Phone Number

Area Code Phone Number
If appropriate - Date retired or release from active duty
Brief statement of how commission was obtained
Decorations, ribbons, medals, commendations, citations and other awards
Remarks concerning military assignments or civilian employment (Optional)
REQUIRED CERTIFICATION: I certify that the statements and answers presented on this application, including any accompanying data, is true and complete to the best of my knowledge and belief.
Date of Cerification

Month Day Year
MEMBERSHIP DIRECTORY AUTHORIZATION: I hereby authorize the release and use by the Marine Corps Mustang Association, Inc. Of the information presented on this application and grant permission to communicate via email, publish and distribute it to its members in the MEMBERSHIP DIRECTORY. This authorization includes publishing my name in any of the quarterly, MESTENGO newsletters. A photo copy of this authorization shall be valid as the original.
Date of Authorization

Month Day Year
How Did You Find Out or Hear About MCMA?
Full Name *

First Name Last Name
Rank / Status *
Signature *
Recommendation Date *

Month Day Year
SELECT PAYMENT OPTION *

Mail Check Pay by Credit Card

IF YOU PREFER TO PAY BY CHECK, PLEASE MAIL CHECK FOR $40.00 MADE PAYABLE TO “MARINE CORPS MUSTANG ASSOCIATION, INC.” ADDITIONALLY ENCLOSE YOUR DD214(s) WHICH SHOW YOUR ELIGIBILITY FOR MEMBERSHIP OR OTHER OFFICIAL DOCUMENTATION SUCH AS A COPY OF THE APPOINTMENT AND ACCEPTANCE RECORD WHICH IS FILED IN THE OFFICERS QUALIFICATION RECORD. DEPLOYED ACTIVE DUTY MARINE WARRIORS ARE EXEMPT FROM THE DD214 REQUIREMENT UNTIL RENEWAL. MAIL TO:

MARINE CORPS MUSTANG ASSOCIATION, INC.
PO Box 190
Quantico, VA 22134

MCMA Membership - CREDIT CARD PAYMENT

1-Year Membership $ 40.00

3-Year Membership $ 90.00

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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Marine Corps Mustang Association, Inc. - Membership Application

How Did You Find Out or Hear About MCMA?