United States Army Black Aviation Association, Inc.

Membership Application

Name*

Title / Grade*

Status (Retired, Active, etc)*

Spouse Name

Address*

Street Address

City State

Postal / Zip Code Country / Region

Designate Primary Contact Number
Home Phone
- -
Cell Phone
- -
Office Phone
- -

Designate Primary Email
Home Email

Office Email

I consent to the release of my contact information to Active Members:
I consent

Membership Dues and Scholarship Pledge

Annual Dues $60 / Life Membership $400
Enclosed

Select payment type (Annual Dues or $400 for Life Membership)
Annual Dues
Life Membership

Scholarship Pledge Amount
$

Donation Amount
$

Note: Pledge may be paid in part or in full; and in memory of:

Electronic Payments may be submitted via our website www.usabaa.org
Make check payable to USABAA and mail to
USABAA
ATTN: COL (Ret) Michael Freeman
P.O. Box 487
Springfield, Virginia 22150-0487
Telephone: (888) 855-9984
E-mail: freemanme@aol.com
Website: http://usabaa.org

Note: Regular Dues paid after January 1, 2017, establishes currency until July 31, 2018

Your active participation will be highly appreciated. Please indicate your area of interest below:
New Membership
Scholarships
Youth Outreach
Active Duty Outreach
Engaging Current Members
Policies
Corporate Outreach
Event Planning

BY SIGNING BELOW MEMBERSHIP APPLICANT ACKNOWLEDGE, UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS. YOUR TYPE WRITTEN NAME REPRESENTS YOUR SIGNATURE.

Applicant Name*

Date of Applicant Signature*