SGAUS Membership Application/Renewal Form

To apply for or renew your membership, please print, complete, and mail the following form to: State Guard Association of the United States P.O. Box 1416, Fayetteville, Georgia  30214-1416 Phone: (770) 460-1215

Please print or type the requested information.

New Membership

Renewal Membership Number _________________________________________________________

Name (Last):

First:

MI:

Rank: (i.e. Mr., MSG, COL(AL), MAJ(AUS Ret))

SSAN:

Source of Rank: Please indicate the authority that granted you your current rank: Federal Government:______________________________ State Government (SDF or StateGuard): ___________________________ Active:_____________________________ Reserve:_________________________ National Guard:__________________________ State?____________ Other: ( Please be specific)____________________________________________________________________

Status: Please indicate your current service status with the organization that granted your rank: Active: Federal_______________________________ SDF:____________________________ Other:__________________________ Inactive: Federal______________________________ SDF:_____________________________ Other:________________________ Retired: Federal:_____________________________ State: ___________________________ Other:_________________________

Mailing Address:

City:

State:

ZIP:

Phone (H):

Phone (W):

Email:

Fax:

State of Membership:

Unit or Affiliation:

Please indicate your profession or area of specialty:

Recruited by:

DUES

1 year

3 years

5 years

SGAUS Dues:

$

Enlisted/NCO

$16

$45

$75

Tax-Deductible SGAUS Foundation Donation:

$

Officer/Civilian

$25

$70

$115

State/Chapter Dues:

$

General Officer

$30

$85

$140

Enclosed is my check payable to SGAUS:

$

Note: If dues are paid through your state chapter, your membership card will be mailed when dues are received by the SGAUS National Office.

Signature:

Date: