Basic Dues Amount: Annual $15.00 [ ] OR 5 Yrs $60.00 [ ] for Currahee newsletter/Company Roster listing
Full Dues Amount: Annual $25.00 [ ] OR 5 Yrs $100.00 [ ] for Currahee newsletter/2010 Association Roster
Purple Heart Dues: Annual $10.00 [ ] OR 5 Yrs $40.00 [ ] for Currahee newsletter/your Era Roster Listing
            [OPEN TO ONLY ACTIVE DUTY PURPLE HEART RECIPIENTS.]
Request for Exemption from Dues (Veterans only): [ ] Receive newsletter only
Additional postage to address outside U.S. : $ 5.00 [ ]
Optional Donation for Expenses: $___________
TOTAL AMOUNT ENCLOSED: $___________
Select [X] ALL that apply:
Company: HQ/HHC/HHT/HHB[ ]  A[ ]  B[ ]  C[ ]  D[ ]  E[ ]  F[ ]  G[ ]
                    H[ ]  I[ ]  K[ ]  L[ ]  M[ ]  SV[ ]  Mortar Battery[ ]  CSC[ ]
BN: REGT[ ]  1st ABN BG[ ]  1st BN[ ]  2nd BN[ ]  3rd BN[ ]  BdeCMD[ ]
            4th BSTB [ ] 801st BSB [ ] 1-61st CAV [ ] 4-320th FA [ ]
ERA: WWII 1942-1945 [ ]    Training 1948-1956 [ ]    1st ABN BG 1956-1964 [ ]
            ABN INF 1964-1967 [ ]    Vietnam 1967-1971 [ ]    AMBL 1972-1974 [ ]
            AASLT 1974-1984 [ ]    Korea (2ID) 1987-2004 [ ]    Iraq (2ID) 2004-2005 [ ]
            506th RCT/4BCT 2004-present [ ]

If applicable, your unit which was assigned to or supported the 506th: _________________

Dates of Service with each 506th unit (mm/yy): __________________________________

Rank (Current or at Date of Separation from Military): ____________________________

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: __________________________

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