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
I am on a free membership
Method of Payment
If Check please include check number and Mail payment to 193rd SOW Association 81 Constellation Court #14 Middletown Pa 17057:
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Document Name: 193 Application
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