Membership Application

Last Updated

12/30/08

PAYMENT ENCLOSED FOR:				TYPE OF MEMBERSHIP REQUESTED

New member.........________			Regular Membership......$25.00________
Reinstatement......________			Associate Membership....$25.00________
Annual Dues........________			Currently on Active Duty.$10.00________
Other (note).......________			Life Membership........$200.00________ 

TOTAL AMOUNT ENCLOSED______________

Make checks payable to "2nd Indianhead Division Association," and mail along with application to: Bob Haynes, Sec/Tres., PO Box 218, Fox Lake, IL  60020-0218.

PLEASE COMPLETE THE FOLLOWING

NAME_________________________________________ADDRESS______________________________________________

CITY, STATE,ZIP____________________________________________________________________________

TELEPHONE____________________________E-MAIL_____________________________________________

YOUR SERVICE WITH THE 2ND DIV (CO., BTRY, REGT)___________________________________________

DATES OF SERVICE-FROM____________ TO_______________WHERE SERVED______________________

SPONSORED BY THE INDIANHEAD WEB SITE...

Print out the application, fill it out and mail it in today. We'll be waiting.