APPLICATION FOR MEMBERSHIP

MARINE CORPS LEAGUE

NAME: _____________________________________________ PHONE: ___________________________

STREET: _______________________________________________________________________________

CITY: ______________________________________ STATE: ______________ ZIP: _________________

DATE OF BIRTH: _________________ DATE OF ENLISTMENT/COMMISSIONING: __________________

DATE OF DISCHARGE/SEPARATION/RETIREMENT: __________________________________________

SSN: ___________________________________ TYPE OF APPLICATION: ___ NEW ___ RENEWAL

___ DUAL ___ ASSOCIATE ___ REGULAR

Spouse: ______________________________________ Email: _______________________________

I HEREBY APPLY FOR MEMBERSHIP IN THE NORTHERN COLORADO #785 DETACHMENT,

MARINE CORPS LEAGUE AND ENCLOSE $32.00 FOR ONE YEAR’S MEMBERSHIP.*

Mac McCormick Commandant Solomon Martinez James Meininger

Home 970-484-9143 970-593-1612 970-461-1248

Cell 970-218-8534

* INCLUDES FREE SUBSCRIPTION TO MARINE CORPS LEAGUE MAGAZINE.

I HEREBY CERTIFY THAT I HAVE SERVED AS A U.S. MARINE FOR MORE THAN 90 DAYS,

THAT THE CHARACTER OF MY SERVICE HAS BEEN HONORABLE, AND IF DISCHARGED,

I AM IN RECEIPT OF AN HONORABLE DISCHARGE. BY SIGNATURE ON THIS APPLICATION,

I HEREBY AGREE TO PROVIDE PROOF OF HONORABLE DISCHARGE/SERVICE UPON REQUEST.

_____________________________________ ______________________________________

SPONSOR – WHERE APPLICABLE APPLICANT’S SIGNATURE

PLEASE ATTACH A COPY OF YOUR DD214 OR DISCHARGE AND MAIL TO:

MARINE CORPS LEAGUE DET #785

PO BOX 1239

LAPORTE, CO 80535-1239