AMVETS Riders
                                                            RANDOLPH CHAPTER 51
                                                                     9 AMVETS LANE
                                                                RANDOLPH, MA 02368                          

                                APPLYING FOR:          ______ RIDER        
 _____ SUPPORTER

NAME: ________________________________________________________________________________

ADDRESS:_____________________________________________________________________________

CITY___________________________________________________STATE: __________ZIP:___________

EMAIL__________________________@______________.com    PHONE:  (____)____________________


Parent Organization:    AMVETS Post: ____    Ladies Auxiliary:_____     Sons of AMVETS Squadron: _____



Membership Number: ___________________        Post/ Dept (if different from above): _______

Applicant Signature :___________________________________  

Authorizing Officer:  ___________________________________

Chapter President: ____________________________________

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RECEIPT and Temporary Membership

DATE_____________        Chapter:____________        Dept. :________________

Dues Received from:________________________

CASH_____  CHECK_____   CHECK #_________

AMOUNT $___________

Received by: ___________________________

Signature: _____________________________

Phone:  (____)_________________________

Rev1: 01/22/2017 <K>
Print (Ctrl-P) this form and complete it. Place it in an envelope,
along with your attached DD 214 or other documentation and a
check for dues in the AMVETS Riders' mail box in Post 51 to
process it.