3rd Bn, 4th Marines Association


Membership Application 
Please print and mail to the address at the bottom.
 

Name_______________________________ Phone #(Hm)_______________(Wk)__________________
 

Address_____________________________ City______________ State______ Zip Code___________
 

Rank______ Active/Discharged/Retired_______ Period of Service(From)__________(To)___________
 

Personal Awards/Decorations:_____________________________________________________________

(Purple Heart, Etc.)

_____________________________________________________________________________________
 

_____________________________________________________________________________________
 

Period of Service with 3rd Battalion, 4th Marines: (From)_______________(To)___________________
 

Unit(s) assigned to while with 3rd Battalion, 4th Marines: Company_________ Platoon____________
 
 
 

How Did You Find Out About The Association? Friends Leatherneck___ VFW___MOPH___

WWW Internet___ MC Gazette___ DAV____ CALTRAP___ VVA___ American Legion___

Other(Please Specify)_______________________
 
 
Dues Information 
Note: Print this form out and mail in with your check.

Annual Memberships:    $25 
 


Make Checks payable to:

3rd Battalion, 4th Marines Association
Chuck Lear
24907 Hertzog Lane
Lees Summit, MO 64086
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*** Locator Guide ***


(Optional) 

The information below will be used to create a 3rdBn, 4thMar Association "Locator Guide) for members.
 

Name __________________________________________ USMC/USN___________________
 

Last Rank Held ___________________ Nickname ______________________
 

Address __________________________________ City _____________ State _____ Zip Code _____
 

Date of Birth _____________ With 3rd Bn, 4thMars from ______ to ______ CO ____ Plt____
 

Places served with 3rd Bn, 4thMars _______________________________________________________
 

Hometown while with 3rdBn, 4thMars_____________________________________________________
 

Would like to locate the following members: ________________________________________________
 

_____________________________________________________________________________________
 

Phone Number: _____________________________ May we give it out? Yes___ No____
 

If some one requests your address, do you want it given out or do you want
their information forwarded to you first? Give Out________ Forward theirís ___________
 

Any Additional Information? ____________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________