Membership Form

Name:_________________________________________ Rank:_____________

Home Address:________________________________

State:______________ Zip:________________

Home Phone:_____________________________

Cell Phone:_______________________________

E-Mail Address (Required):_____________________________

Total years of military service: ___________

Years in the 42^nd Infantry Division: ________

Major Unit: __________________________________________

Dues Schedule: One Year: $25.00 ______

Lifetime:      Age             Rate                  Age             Rate

                      80 and over $75.00              61 to 65 $185.00

                      76 to 79      $105.00              56 to 60 $190.00

                      71 to 75      $130.00              51 to 55 $210.00

                      66 to 70      $180.00              50 and below $220.00

Please make checks out to: “42 Div Rainbow Assn”