TOLEDO, OHIO 43623

Date:________________________________________

Full Name:____________________________________

First Middle Last

Grade:_______________________________________

Service:______________________________________

Active Duty

Retired Reserve

Former Officer National Guard

Widow(er) Regular

Mailing Address:______________________________

Number and Street

City_StateZip

E-mail Address:_______________________________

Telephone:___________________________________

Birthday:_____________________________________

Spouse’s Name:_______________________________

Spouse’s Birthday_____________________________

Day and Month only

Anniversary__________________________________

I am I am not a member of MOAA National

MOAA Number________________________________

Signature____________________________________

Auxiliary member Fill in your own name, address, etc. Show deceased spouse’s rank and service

Member Dues: $20.00 per year

New Members Only $10.00 after July 1,

Auxiliary Member Dues: $6.00 per year

New Members Only $3.00 after July 1,

Consider contributing to our Tuition fund which goes to ROTC Cadets and others.

Make checks payable to TAMOAA

Return to:

Toledo Area Military Officers Association (TAMOAA)

P. O. Box 8754

Toledo, Ohio 43623

First Name:

M.I.:

Last Name:

Street Address:

City:

State:

Zip Code:

-

Spouse's First Name:

Social Security No:

Telephone:

Date of Birth
(e.g. 08-AUG-1935):

Email Address:

Rank:

Service:

Check the applicable boxes:

Active Duty Retired Former Officer

Regular Reserve National Guard

Male Female

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