Telephone (       )___________________     [  ] NEW MEMBER       [  ] RENEWAL         [  ] REINSTATEMENT

[   ] Enclosed is $15.00, my membership dues for the year 200__ , subscription to The Paraglide included.

[   ] Enclosed is $16.00, an additional $1.00 for the 82d Educational fund.

[   ] Enclosed is $________ for Life Membership ($150 if under 50 Yrs of age /$100 if over 50 Yrs of age)

Name ______________________________ Street or RFD __________________________________

City _____________________________ State _____ Zip Code (9 digit) ______________-_______

Rank __________ ASN _______________________ or SSAN ___________________________

Airborne Unit (Be complete) __________________________________________________________

Date of Airborne Service: From Month ________Year ____ To: Month ________Year _____

Present Occupation __________________________ Single ___ Married ___ # Children ____

Spouse's Name __________________________Home Telephone (            ) __________________