ORLAND MEMORIAL POST 111

AMERICAN LEGION

Membership Application

Yes! I will help my fellow veterans by becoming a member of The American Legion.

I certify by forwarding this application that I served at least one day of active military duty during the dates marked below and was honorably discharged or am still serving honorably. I am submitting forty ($40.00) dollars for annual membership in the American Legion, along with a copy of my DD-214 discharge form, or a copy of my current Military Identification Card to: ORLAND MEMORIAL POST 111, P.O. BOX 413, ORLAND PARK, IL 60462.

Prefix: (Ex: Dr, Rev, Ms, Mrs, Mr.) ______

First Name ________________Middle Initial ___ Last Name _______________________

Suffix (Ex: Sr, Jr, ) ______ Date of Birth (MM/DD/YYYY) ____/____/_______

Address Line 1 _____________________________________________________________________

Address Line 2 _____________________________________________________________________

City __________________________________State _________Zip Code_____________

Phone No. (_____)_____________________ E-Mail ____________________________

                      Dates of Service                                                                                         Branch of Service

___ Aug 2, 1990 to Present                                                                                         ___ US ARMY

___ Dec 20, 1989 to Jan 31, 1990                                                                              ___ US AIR FORCE

___ Aug 24, 1982 to Jul 31, 1984                                                                               ___ US COAST GUARD

___ Feb 28, 1961 to May 7, 1975                                                                                ___ US MARINE CORPS

___ Jun 25, 1950 to Jan 31, 1955                                                                               ___ US NAVY

___ Dec 7, 1941 to Dec 31, 1946                                                                                  ___US MERCHANT MARINES

                                                                                                                                                            (12/41 to 12/46)

(Signed) ______________________________________________________

Date____________________________