Full Name: Rank:
Date of Birth: Spouse Name:
Street: City: State: Zip:
Home Phone: Cell Phone:
Total Time of Service: Time Served with the 193rd:
Last Squadron Assigned:
Email address: Use personal email address, not military
Annual Membership $15.00. Lifetime Membership (to determine your dues, subtract your age from 100 andmultiply that by three) Membership shall run from 1 January to 31 December. Dues paid after 1 October will be applied to the next year.: Type Membership
Method of Payment
You can pay your dues online at this web link.
If Check please include check number and Mail payment to 193rd SOW Association 81 Constellation Court #14 Middletown Pa 17057:
You can sign by accepting the way the system presents your name or actually sign it with your mouse or finger on mobile devices.
When signed online you can download the PDF for your records.
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Document Name: 193 Application
Agree & Sign