SOUTH COAST CHAPTER
MEMBERSHIP APPLICATION FORM
NAME __________________________ RANK ________ SERVICE ___________
ADDRESS __________________________________________________________
CITY ________________________ ST _________ ZIP +4 ________ - __________
TELEPHONE __________________ SPOUSE NAME _____________________
MOAA MEMBERSHIP NUMBER _____________________________
E-MAIL ADDRESS _____________________________________
Membership dues for one year: $15
After July 1, dues for rest of the year: $7.50
After October 1, dues are $15 and are credited through the following year.
Please make checks payable to:
South Coast Chapter
Mail completed form and payment to: CDR
William C. Manes, Membership Chairman
25665 Fishermans Drive
Dana Point, CA 92629