Membership

AAONHC

Membership Application

Full Name

Nickname

Date of Birth

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number (With Area Code)

I would like for my phone and e-mail address listed in the roster.

Yes

ANNUAL DUES ARE $20.00 PER YEAR (Jan 1st to Dec 31st)

New Member

Renewal

Life membership fees:

Age 18-35 $450.00 $38.00 per month for one year

Age 36-50 $350.00 $30.00 per month for one year

Age 51-65 $250.00 $21.00 per month for one year

Age 66-79 $180.00 $15.00 per month for one year

Age 80-older $125.00 $11.00 per month for one year

LIFETIME PAYMENTS MUST BE MADE WITHIN ONE YEAR FROM DATE REQUEST
WAS MADE or revert to annual dues.

Spouse’s Name

Present Rank or Rank at the time of discharge:

Military Retired

Yes

Quals (Select All That Apply):

NEC(s):

Dates of Service

Conflicts:

Please enclose a copy of your DD214. (Application and 214 will be verified and shredded.)

Would you like to purchase a copy of the Membership Roster?

Yes (The cost for the roster is: $10.00 + $4.50 for printing, shipping and handling.)

Please select how you would like to receive your quarterly newsletter:

By Regular Mail

By Email*

Email Address for Newsletter

Click the link below to pay online. Or you can mail your payment to Paul Denis using the address to the right.

SEND DUES AND MONIES FOR THE ROSTER TO:
Paul Denis Treasurer/Membership
8185 Chianti Circle
Clay, NY 13041

American Association of Navy Hospital Corpsmen