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P.O.!Box!396,!Barksdale!AFB,!LA!71110! barksdaleosc@gmail.com! www.barksdaleosc.com!

! $50!per!year,!if!paid!prior!to!August!31,!2013! $55!per!year,!if!paid!September!1!–!May!31,!2014! BOSC%Annual%Membership%dues%are%as%follows:! $30!per!year,!if!paid!January!1!–!May!31,!2014*! *For!spouses!new!to!Barksdale!past!1/1/14!only!

Please!make!check!payable!to!BOSC.!!Your!canceled!check!or!emailed!receipt!confirms!membership.!This!form!and! payment!may!be!paid!through!our!website,!PayPal,!brought!to!any!function!or!mailed!directly!to!the!above!address.! There!is!a!$2.00!transaction!fee!for!all!dues!paid!via!PayPal!to!barksdaleosc@gmail.com.! Name:!

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Address:!

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City:!

State:!

! Home!Phone:!

Cell!Phone:!

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Email!Address:!

Zip:!

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Birthday:!

Wedding!Anniversary:!!

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(MM/DD)!

Spouse’s!Name:! Spouse’s!Rank:!

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(MM/DD/YYYY)!

Branch:!! Spouse’s!Unit:!

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Child!#1:!

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Age:!

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Child!#3:!

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Age:!

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Child!#2:!

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Age:!

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Child!#4:!

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Age:!

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Membership!Status:! I!am!a:! New!Member!

Returning!Member!

Associate!Member

Social!Member!

Permanent!Reservation:! Yes I!would!like!to!be!added!to!the!permanent!social!reservation!list.!I!understand!that!I!will!be!charged!if!my!cancel! reservation!is!not!canceled!by!Noon!the!Thursday!prior!to!a!social.!Cancel!reservations!by!emailing! No boscreservations@gmail.com! Special!Activity!Interest:! Book!Club!

Bowling!

Bunco!

Crafting!

Fitness!

Golf!

Gourmet!

Lunch!Bunch!

Play!Date!

I!am!interested!in!volunteering!for!the!following!committee!position!if!it!becomes!available:! Social!

Community!Rep!

Hail!&!Farewell!

Member!Services

Webmaster

Newsletter

Reservations!

Volunteer!

Charitable!

Ways!&!Means!

Property!Manager

Scholarship

Historian

Newsletter!

Photo!Consent:! I!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(print),!hereby!consent!to!allow!full!use!of!photographs!taken!of!me!during! Barksdale!Officers’!Spouses’!Club!functions,!events!and!activities!to!be!used!for!the!following!applications:! Yes! No! For!internal!rosters!and/or!newsletters!for!BOSC!members:! Yes ! No! For!www.barksdaleosc.com!(public!access!portions!of!the!website):! Yes! No! For!general!advertising,!publicity,!or!promoting!on!Barksdale!AFB:! Member!Signature:!! !

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Date:!

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For%Membership%Use:% Payment!Date:!___________!!

Cash!

Credit!

PayPal!

Check!__________!!MidfYear?!!

Yes!!

No!

______ Welcome!Email!Sent!______!Added!To!Roster!______!Gmail!Updated!______!Little!Clubs!Notified!

Notes:! !

Initials:!_____________!

2013 14 BOSC Membership Form  
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