Brotherhood of Dak To Defenders

Membership Application

 

REGULAR MEMBERSHIP -  (1 year) - $20.00 REGULAR MEMBERSHIP -  (3 year) -  $50.00 Regular Applicant must have served with the 299th CBE between the dates of May 9 through July 1, 1969 during the Siege on Dak To, Vietnam.   ASSOCIATE MEMBERSHIP – (1 year) - $20.00 ASSOCIATE MEMBERSHIP – (3 year) - $50.00 Applicants must have served with the 299th CBE at any time regardless of location or era.                                                                                       Life Member...........$200.00 Applicants must be Regular or Associate eligible *Contact Treasurer for Life Membership Installment Plan                                                                                                          Circle One

NEW MEMBER-                 RENEWAL MEMBER-

Name:  __________________________________________________________________________________________

Street: 

_________________________________________________________________________________________

City:     __________________________________ State:  _________________________ Zip:  __________________

Telephone Number:  ___________________________  E-Mail Address:  ___________________________

Membership Status:  (Circle One)       Regular Member      Associate Member            Life Member  

Veteran Status: (Circle One)  World War II    Vietnam    Germany    Lebanon  Iraq    Other____________

Dates Served:  (Dak To) ___________________________   (Other)  ______________________________

                                    (A request for a copy of your DD-214 may be required)

Member’s Signature:  __________________________________________   Date:  ___________________

WE REQUEST IMMEDIATE NOTIFICATION OF CHANGES IN YOUR E-MAIL-ADDRESS-TELEPHONE NUMBER

** PLEASE COMPLETE ALL SECTIONS OF THIS APPLICATION**

Please complete the following questions so we can better serve our membership

Company(s) Served: ______________________________________ Dates: 

____________________________________

What was your MOS and where was your location assignment: 

_______________________________________________

Nick Name or preferred name for use on name tags at events:

_______________________________________________

Spouse or Significant Other’s first (last) name:  __________________________________________________________

ALL DUES PAYMENTS MADE PAYABLE TO: BROTHERHOOD OF DAK TO DEFENDERS, INC.

PLEASE FORWARD YOUR APPLICATION AND CHECK TO:

JAY GEARART – TREASURER

9668 WOODYS RUN

TRAVERS CITY, MICHIGAN 49684

E-MAIL – JAYBIRD718@CHARTER.NET---TELEPHONE – (231)-922-3471