U.S. Military Retiree Association of Southern Italy (USMRA-SI)

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Renewal Form

Membership Renewal Application

Name:

Uniformed Service:
Status:

Date of Birth: Retirement Date:

Retired PayGrade



Paygrade


Mailing Address
Street Address:

FPO/APO: AE: ZIP:

Home Phone: Work Phone:

Cell Phone:


EMAIL


Annual Dues: Select one form of Payment: