Adjutant, Squadron 280

469 N. Battlefield Blvd

Chesapeake VA 23320

First Name: Middle Initial (as req'd)

Last Name: Suffix:

Date of Birth:

Telephone Area Code: Telephone Number:

Mailing Address: Apt.#:

City: State: Zip:

E-mail Address:

My annual dues will be paid (in accordance with the chart below) by: Personal Check: Money Order: Cashiers Ck.

$15.00 if your age is 15 years of age and below.
$20.00 if you are older than 15.
$15.00 if you are also a member of The American Legion (holding dual membership)

You must complete all appropriate entries

A copy of the applicants qualifying veterans DD 214 or active duty ID card. - (to be returned).

I certify and acknowledge that the above information is true.

Signed: ____________________________, Dated: ______________