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Application for Membership
Name*:
Service or SSN#*:
Street*:
City*:
State*:
Zip Code*:
Date of Birth*:
Date of Enlistment/Commissioning*:
Date of Discharge/Separation/Retirement*:
Rank at Time of Discharge*:
Phone*:
Email Address*:
Type of Application*:	New Member ($30)Renewal ($30)Associate ($30)
I agree to the below terms of this application*:	Yes
Verification:	=  Fill in the result

I hereby apply for membership in the Kentuckiana Detachment #729 and will pay $30 for one years membership which includes a monthly newsletter and the quarterly Marine Corps League magazine. I hereby certify that I have served as a U.S. Marine (or FMF Corpsman) for more than 90 days (exception for associate member); that the character of my service has been honorable and if discharged, I am in reciept of an honorable discharge/service verifiable upon request. (Ver. 08)