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NCNGA Membership Application Please type (or print clearly) Name: _______________________________________________________________________ Address: _____________________________________________________________________ City: _____________________________________ State: ____________ Zip: ______________ Unit: ________________________________ Social Security # _______ - _______ - _________ ____ I prefer to receive my magazine via e-mail. E-mail Address: ______________________________________

************************************************************************ Membership Type (please check one): (1 JAN – 31 DEC)

____ Annual ($15) ____ Life ($250)

____ *Life dues installment plan option *Life dues may be paid in quarterly installments of $62.50 each. The first installment of $62.50 must accompany your application. Life dues (and any portion paid towards life membership) are non-refundable. Credit Card Payment: _____ MasterCard

_____ Visa

*If paying with a credit card, please add $3 for processing.

Name on Card: ___________________________________________________ Card No. ________________________________________________________ Expiration Date: _________________ 3 digit card security code_____________ Signature: _______________________________________________________ Return the completed application and dues payment to: (check/money order/credit card - please do NOT send cash)

NC National Guard Association 7410 Chapel Hill Road, Raleigh, NC 27607-5047 919-851-3390 or 1-800-821-6159 (NC only) Fax 919-859-4990 www.ncnga.org email: ncnga@bellsouth.net **Annual and Life dues are not deductible as a charitable contribution**


ncnga-membership-application