Armed Forces E9 Association
Keystone Chapter
Application for membership
(Use your browser to print this application, then Please PRINT or TYPE CLEARLY)

Please enroll me as a member of the Armed Forces E9 Association (AFE9A).  I further request that I be listed as a member through the KEYSTONE  CHAPTER of the AFE9A.  I have enclosed $____________ in payment of my membership dues as indicated (Check one):
 Annual
(  ) 1 Year - $25.00       (  )  2 Years - $48.00           (  )  3 Years - $70.00
Life Membership
Under 51 - (  ) $250.00     (  ) 4 Quarterly payments of $62.50 each)
 51 - 55 -     (  ) $225.00     (  ) 4 Quarterly payments of $56.25 each) 
56 - 60 -     (  ) $200.00     (  ) 4 Quarterly payments of $50.00 each)
61 - 65 -     (  ) $175.00     (  ) 4 Quarterly payments of $43.75 each)
66 - 70 -     (  ) $150.00     (  ) 4 Quarterly payments of $37.50 each)
Over 70 -   (  ) $100.00     (  ) 4 Quarterly payments of $25.00 each)

PERSONAL  INFORMATION

NAME _______________________________________________________________________
                              (Last)                                            (First)                                     (MI)

ADDRESS ____________________________________________________________________

 ____________________________________________________________________________

_____________________________________________________________________________
            (Post Office)                                       (State)                                 (Zip + 4)

 Check one: (  ) Retired  (  )  Active   (  ) Inactive Reserve/National Guard

 Rank _________________________________  Branch______________________________ 
    (CMSgt, CSM, SGM, SgtMaj, MCPO,  etc. NOT E9)          (USA, USAF, USCG, USMC or USN)

 Retirement Date _______________________________
                                  (Mo/Day/Year)

 Home Phone ________________________    Work Phone (Optional) ___________________

 E-mail Address ______________________________________________________________

 Date of Birth _____________________            Spouse's First Name _____________________
                                (Mo/Day/Year)

 Signature ________________________________ Date of Application_____________________
                                                                                                                          (Mo/Day/Year)

Recruiters Name _______________________________________________________________

Do not write in this space  For National Use Only. 

Membership#__________ Effective____________ Expires _____________

Complete the application and make your check or money order payable to:

Keystone  Chapter, AFE9A