NEW YORK GUARD ASSOCIATION, INC. P.O.Box 220346 Brooklyn, NY 11222-0346 1-888-NYGUARD

APPLICATION FOR MEMBERSHIP

1. Name (last, first, mi):____________________________________________________
2. Current Military Rank:___________________________________________________
3. Current mailing address:__________________________________________________
   ............................. _______________________________________________________
   ............................. _______________________________________________________
   ............................. APT. #:____________________ ZIP+4:______________________
4. Current military assignment:
   1. NYG (unit):_______________________________
   2. NY State Reserve List: (__)
   3. NY State Retired List: (__)
   4. CIVILIAN: (__)
   5. Other (explain): ___________________________
5. Is this application: (____) New Membership (____) Renewal
6. Please remit your check/money order drawn to the order of "NY GUARD ASSOCIATION, INC." and mail to the above address. NO CASH PLEASE!
   1. (___) Annual Membership payment.
   2. (___) Contribution/donation (tax deductible to extent of Internal Revenue Code).
   3. (___) Life Membership payment - date of birth __________