Name (Last, First, MI)	* required
Date of Birth (DD,MMM,YYYY)	* required
Rank	MGen BGen Col LtCol Major Capt LT Other
Spouse Name
Nbr & Street	* required
Apt, Unit, etc.
City or "APO"	* required
State (or if APO/FPO, AE, AP, etc.)	* required
Country	* required
Phone	* required
EMAIL	* required
Status	Active Duty Reserve Air National Guard Former (not retired) Retired
Method of Payment	Credit Card via PAYPAL Check by Mail Free (Assn Invite for Promotion, HSA, Retirement, etc.)
Agree to my info being published in the Directory	YES NO
Include me on Project Connect (jobs) messages	YES NO

MEMBERSHIP TYPE

REGULAR RENEWAL $20.00 AD 01-04 RENEWAL $15.00