MARINES’ MEMORIAL ASSOCIATION MEMBERSHIP APPLICATION Fax to: 415.563.5820 Mail to: 609 Sutter St., San Francisco, CA 94102 Welcome Aboard!


60th anniversary our living memorial membership benefits


Membership Categories (All donations are tax-deductible and non-refundable): □ Regular Veteran & Retired, all US Services, including Merchant Marine (wartime): Annual donation $125.00 ($25.00 initiation fee)


□ Currently Serving Members of the Armed Forces All Services $35.00 (Rates remain the same until personnel departs Active/ Reserve status, then normal member rates apply)


□ Benefactor Veteran, Retired, or Currently Serving. Benefits include: Engraved name plate, room upgrade at no additional cost (based on availability at check-in), advanced special events reservations, 15% discount in the Leatherneck Steakhouse, 15% discount on Memorabilia. □ Individual Plan One time donation of $2500.00 (Includes primary and spouse) □ Family Plan One time donation of $3500.00 (Includes primary, spouse and family guest cards at no additional charge)


Membership Information (Please print clearly) First Name, MI, Last Name: ________________________________________________ Branch of Service: □USMC □USN □USA □USAF □USCG □Merchant Marine (wartime) Military Status: _____________________ Highest/Current Rank: _____________________ Birth Date: ____ / ____ /19_____ Email: ______________________ @ _________________________ Address: ________________________________________________________________ City: ___________________________________ State: _________ Zip: ____________ Home Phone: _________________________ Fax: _____________________________ I certify that I served on Active Duty in the US Armed Forces from __________ to __________


How did you hear about us? □Advertisement or news article (Name of publication: _____________________________)


□Visit to the Club or Theater □Member/family/friend □Site presentation □Other ______________________


Family Members Your spouse, children over 21 years (who are ineligible for membership by themselves) and non-military parents are eligible for Guest Cards. Spouse card is complimentary; all others are $50 annually, per Guest Card. Please list names, relations and ages of those for whom you would like to add a card (use reverse side if necessary). In-laws are ineligible.


Last Name First Name MI Relationship


Processing Your Membership Application In addition to the completion of this application, please attach the following:


• Photocopy of Official Verification of Honorable Service: DD214 or Retired ID Card; copy of front of Active Duty ID Card (Currently Serving only) Note: If you cannot locate verification or know that it has been lost, you can obtain a copy by writing: National Military Personnel Records Center, 9700 Page Blvd., St. Louis, Missouri 63132. Or complete the online form at: http://www.archives.gov/veterans/military-service-records/index.html


• Appropriate Donation (All donations are tax-deductible and non-refundable)


Circle Payment Type: MC VISA AMEX Diners Club Personal check or other: ________________ Total Amount Due (membership donation + guest card(s)) $ ____________ Credit Card # ____________________________________ Exp. Date ____________ Signature of Applicant ___________________________________ Date ________________ Referred by ___________________________________________


Contact Us: phone 415.673.6672 x223 Toll-free 800.5.MARINE fax 415.563.5820 Member@MarineClub.com www.MarineClub.com Crossroads Winter 2011-12 23 Age Amount


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Marine for Lifelooking back


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