Basic Dues Amount: Annual $15.00 [ ] OR 5 Yrs $60.00 [ ] for Currahee newsletter
Full Dues Amount: Annual $25.00 [ ] OR 5 Yrs $100.00 [ ] for Currahee newsletter/2010 Association Roster
Additional postage to address outside U.S. : $ 5.00 [ ]
Optional Donation for Expenses: $___________
TOTAL AMOUNT ENCLOSED: $___________

Last Name: _____________________ First Name: _________________ M.I. ____

Street Address /PO Box: _______________________________________________

City: ____________________________ State: _______ Zip Code: _____________

eMail Address: _______________________________________________________

Phone Numbers (Please include area code):

Home: _________________________ 2nd Phone: __________________________

Did either you or your spouse serve in the U.S. Military?
If yes, please include the following:
Branch of Service: _____________ Unit: __________________________________
Dates of Service: ______________________________________________________

Did you have a relative who served with the 506th Infantry?
If yes, please include the following:
Veteran's Name: _____________________________________________________
Relationship: ________________________________________________________
Company: __________ REGT/BN/BG: ____________________ Rank:_________
Dates of Service with the 506th Infantry: _________________________________

Other connection to the 506th Infantry? _________________________________

Select [X] one or more of the following options if they apply:
Change [ ] Add [ ]: Name [ ] Mailing Address [ ] Phone number(s) [ ] eMail [ ] Other [ ]
[ ] I request my contact information not be listed in either the 506th Association Roster or the Currahee
eMailRoom, nor that it be given to anyone other than an Association Officer without my express consent.
Make your check or money order (no credit cards) payable to:
The 506th Airborne Infantry Regiment Association (Airmobile-Air Assault)
Mail this Membership Dues/Donation Form and your check to:
Hoyt Bruce Moore, III, Treasurer
4126 Cole Way
San Diego, CA 92117-1123