| PRINT OUT FORM PRINT OUT FORM PRINT OUT FORM |
| Membership is open to any person who is now serving or has served in the 15th Infantry Regiment |
| Name:_______________________________ First:_________________________Middle Initial:__________ |
| Last First |
| Address:__________________________________City:__________________State:______ Zip+4:________ |
| Telephone:__(______)____________________________E-Mail Address:____________________________ |
| Rank:______________Date of Birth:________________Dates served in the 15th:______________________ |
| Co & Bn. Served In:________________________________________________________________________ |
| Retired: Yes No ( Circle One ) Spouse's Name:__________________________________ |
| Your Signature:____________________________________ |
| Type of membership desired:
Regular Annual $10.00 □ - Active Duty $5.00 □ - Regular Associate Annual $10.00 □ Life Memberships - To Age 60/ $150.00 □ Age 61-69/$120.00 □ Age 70-79/$100.00 □ Age 80+/$50.00 □ |
| Complete application and mail with check or money
order payable to the Treasurer, 15th Inf. Regt. Assn.
Mail to: Bartolo Viruso, Treasurer |