ROCKY MOUNTAIN EAGLES CHAPTER of the st 101 AIRBORNE DIVISION ASSOCIATION 5512 South Telluride Court Centennial, CO 80015-2645 Phone: (303) 680-3758 Website: www.RMEagles.org Please check the applicable box: ( ) New Member ( ) Associate Member ( ) Renewal ( ) Gift* Annual membership: 1 July to 30 June (inclusive). Make Payment to: Rocky Mountain Eagles Chapter at above address ( ) Enclosed is $10.00 check for a one-year membership, or $__________ for ______years membership ($10.00 per year). Note: Membership in the Rocky Mountain Eagles Chapter requires membership in the 101 st Airborne Association. PLEASE PRINT LEGIBLY. Rank/Grade: ____/_____Retired □ Name (Last, First, Middle): _______________________________________________ Address: ____________________________________ City: ________________________ State: _____ Zip: ___________ Phone: ________________ Cell: ________________ Work: ________________ Email: __________________________ Date of Birth (MM/DD/YY): ____________________ Spouse Name: _________________________________________ Home of Record Address (Active Duty): ________________________________________________________________ Please furnish the applicable information and complete those blanks you wish to have as a part of your Association Records: Current or Last 101st Unit**: Co/Btry/Trp: __________ Bn/Sqdrn: ___________ Regt: __________ Bde: __________ Last 101st Unit Dates of Service: From __________________To: _______________ Location: _____________________ Military Associates: Specify branch of service, unit and dates of service if you did not serve with; or, were not attached to the 101st: __________________________________________________________________________________________________ Are you, or were you, the spouse of a veteran: Yes □ Specify Last Unit: ______________________________________ Are you a descendant of a veteran: Yes □ Relationship: ________________ Specify Unit(s): _______________________ ____________________________________________________________________________________________________________________________________________________________________ Other Association Memberships: Association: _________________________________________ Offices Held: __________________________________________ (List additional memberships on reverse side) Civic Activities You Participate In: ___________________________________________________________________________ Occupation: _______________________________________________________________________________________________ *The Rocky Mountain Eagles Chapter of the 101 st Airborne Division Association participates in charities that support veterans and veteran initiatives. Please visit the website for more information. Please mark any gifts to these charities with the appropriate charity name and indicate if you wish your donation to be anonymous. Checks are still made out to Rock Mountain Eagles Chapter and mailed to the above address. SPONSOR (if applicable) _______________________________________________________________________________ ** NOTE: Include other 101 units and/or any other pertinent information on reverse side such as campaigns, awards, other st units served with (include dates and location), etc. □ I Do □ I Do Not authorize the release of my information to Association members. □ I Do □ I Do Not authorize release of my information to other organizations. Signature: __________________________________________________________________________