RANK/TITLE/MR/MRS/MS:________NAME:________________________________________________________
Address:__________________________________________________________________________________
Address:__________________________________________________________________________________
City:______________________________________State:______ZIP:_______________________________
Phone:________________________________E-mail:_____________________________________________
My Military Unit/Organization is/was:_____________________________________________________
STATUS: ACTIVE DUTY
ARNG
USARRETIRED
IRR
CIVILIAN
OTHER______________________
Select Membership Term JUNIOR ENGINEERS:
FOR CURRENTLY SERVING MILITARY SSG-SFC and BELOW, 2LT-1LT, W1-W2, AND CIVILIAN GS-9 AND BELOW.
____ 15 Month Membership for $15.00
____ 27 Month Membership for $25.00
____ 36 Month Membership for $35.00 (Includes a FREE Engineer Regimental Coin for first time members)
ALL OTHERS:
____ 12 Month Membership for $25.00
____ 24 Month Membership for $45.00
____ 36 Month Membership for $60.00
PAYMENT BY CHECK/MONEY ORDER PAYABLE TO "AEA" AND MAIL TO:
Army Engineer Association
PO Box 634
Ft. Leonard Wood MO 65473
VISA/MASTERCARD PAYMENT (Check one)
Expiration Date:_____/_____Card #:__________/__________/__________/__________
Name exactly as shown on the card:___________________________________________________
I authorize a charge of $____________ to the above account number.
(Signed):____________________________________________________________________________
NOTE: Credit card membership transactions may be faxed to 573-329-3203.
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