AMVETS
                                                            RANDOLPH AMVETS POST 51
                                                                       9 AMVETS LANE
                                                                 RANDOLPH, MA 02368                          
        I CERTIFY:

       THAT I AM SERVING OR HAVE SERVED HONORABLY IN THE U.S. ARMED FORCES
       (ACTIVE, GUARD OR RESERVE) AFTER SEPTEMBER 15, 1940.

I AM APPLYING FOR: ______ NEW ANNUAL AND PRESENT $35 FOR DUES
                                    ______ RENEWAL AND PRESENT $35 FOR DUES                     
                                    ______ LIFE MEMBER AND PRESENT $250 FOR DUES

NAME: ________________________________________________________________________________

ADDRESS:_____________________________________________________________________________

CITY___________________________________________________STATE: __________ZIP:___________

EMAIL__________________________@______________.com    PHONE:  (____)____________________

BRANCH OF SERVICE_________ ENTRY DATE: ____/____/____   DISCHARGE DATE:
 ___ /_____/____

SERVICE NUMBER__________________________        DISCHARGE TYPE: _______________________

DATE OF BIRTH____/____/_______   SEX:        M ___  F ___   

NAME OF SPOUSE________________________________



SPONSOR__________________________________         POST__
_51_____

SIGNATURE___________________________________   AUTHORIZING OFFICER: INIT______________

I CERTIFY THAT I HAVE MET THE ELIGIBILITY REQUIREMENTS FOR MEMBERSHIP IN AMVETS AND
WILL BE ASKED TO PRODUCE MEMBERSHIP ELIGIBILITY BY SHOWING MY DD 214, VA CARD OR
DRIVERS LICENSE with "VETERAN" IMPRINTED ON IT OR MILITARY ID/CAC.

SIGNATURE______________________________________________  DATE:  ______________________

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RECEIPT

DATE_________________________

CASH_____  CHECK_____   CHECK #_________   AMOUNT $___________

                                                        
RECEIVED BY:___________________________

Rev2: 01/22/2017  <K>
Print (Ctrl-P) this form and complete it. Place it in an envelope, along
with your attached DD 214 and check for dues in the Senior Vice
Commander's mail box in Post 51 to process it.