Name In Full ____________________________________ Date of Birth __________________
Please circle all that applies to your status- I am the: Wife/Husband/Mother/Father/Sister/Brother/
Widow/Widower/Daughter/Son/Granddaughter/Grandson/Stepdaughter/Stepson/Grandmother/Grandfather of: __________________________________________________________________________________________________ (FRA Members full name) (branch of military service) Your Address _______________________________________________________________________________________ Your City/State/Zip_________________________________________________________________________________ Your Email Address ______________________________ Telephone # (____) _____ - _________
Membership Preference: Nearest Unit ___ Member at Large ___ Payment - Dues are $15 per year: Enclose check payable to LA FRA Applicants Signature ____________________________________________ Date _______________
Proposed By____________________________ LA FRA Membership #_______________ Unit#____________
(name)
_______________________________________________________________________________________________
_______________________Verification of Eligiblity______________________
The above named Fleet Reservist is a member of FRA Branch #_________ (or) The above named Fleet Reservist is deceased and was eligible for FRA Branch membership at the time of death ________________________________________________________________________________________________________________ (date of death) (verified by) (LAFRA Title) (Date)
|
Ladies Auxiliary FRA |