Membership Application

                                                                                      ARIZONA 10-13 MEMBERSHIP/RENEWAL APPLICATION
                                                                                                  01-01-2022 through 12-31-2022

PLEASE COMPLETE ALL INFORMATION (HOME ADDRESS, E-MAIL, PHONE NUMBERS, ETC.) THIS IS USED TO UPDATE OUR FILES  AND ALLOWS FOR BETTER COMMUNICATION.  THANK YOU! ! !

NAME ________________________________________________________________
ADDRESS _______________________________________  APT# __________________
CITY ___________________________  STATE __________  ZIP _________________
HOME PHONE ____________________________________
FAX ____________________________________________
CELL ___________________________________________     
E-MAIL _________________________________________
DATE OF BIRTH ___________________________________
DATE APPOINTED ________________RETIRED ____________
SPOUSE’S NAME ___________________________________ 

CELL ____________________________________________
E-MAIL ___________________________________________
COMMANDS (DATES IF POSSIBLE PLEASE): _______________________________________________________

MEMBERSHIP DUES ARE  $25.00  CHECKS SHOULD BE MADE OUT TO: ARIZONA 10-13  ASSOCIATION. CASH AND CHECKS ARE ACCEPTED AT THE MEETING. OTHERWISE, PLEASE MAIL TO:   

(NOTE NEW ADDRESS) :         

ARIZONA 10-13 ASSOCIATION
16127 E Ocotillo Drive                  

Fountain Hills, AZ 85268-4947
ALL DUES PAYMENTS MUST HAVE APPLICATION ATTACHED! NO EXCEPTIONS PLEASE !