NGAMA/NGAUS MEMBERSHIP APPLICATION

Member Information
* First Name: Middle Name: * Last Name: Suffix: Rank: Select Rank WO1 CW2 CW3 CW4 CW5 2LT 1LT CPT MAJ LTC COL BG MG LG GEN 2d Lt 1st Lt Capt Maj Lt Col Col Brig Gen Maj Gen Lt Gen Gen * Payment amount: Select Payment amount O8 ($179) O7 ($158) O6 ($138) O5 ($110) O4 ($92) O3 ($74) O2 ($55) O1 ($35) CW5 ($98) CW4 ($79) CW3 ($61) CW2 ($45) WO1 ($31) Associate Member (Enlisted or non-military) ($10) Separated ($45) Life Membership Retired ($150) Life Membership Active ($1000) Partial Payments Life Membership (four installments over 2 years) ($250) Service Status: Select Service Status Active Retired Separated
Marital Status:	Select Marital Status Single Married
Dependents:	Yes No
* Address:
* City:
* State/Province:	Select a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* Zip/Postal Code:
* Phone:
* Email Address:
Contact Name:
Military Branch:	Select Military Branch Air National Guard Army National Guard Other - Please Specify
Unit:	Select Unit 1-101 FA 1-181 IN 1-182 IN 101 EN 101 FI DET 101 FS 101 Intel 101 RTI 102 AOG 102 IW 102 Med 102 MSG 102 OPS GP 102 SERV FT 104 Civ Eng SQ 104 COM FT 104 FW 104 LG READ SQ 104 Med 104 MSG 104 MXG 104 OPS GP 104 Services FT 104 SF SQ 104 Student FT 126 BSB 126 MHD 131 Fighter SQ 151 RSG 164 TC 1944 AQ 211 MP 212 EIS 253 CC GP 26 MEB 267 CBCS 3-126 AVN 51 TC 79 TC ARNG Flight DET CO C 1-20 SFG D/233 MI HHD - JFHQ HQ MAANG IO FST JFHQ JFHQ AIR MEDCOM R&R RTI - CE Other - Please Specify
Dues
Title Amount $
Comments
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Payment
Check payable to NGAMA Please send this form and check to: NGAMA Attn: C. Sprouse PO Box 195 Sturbridge, MA 01566   Credit Card You will be able to submit your credit card information securely on the next page. *2.9% service fee will be applied to credit card transactions.