Membership Application

For New or Renewal Memberships

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Name: Sex:

DOB (MM/DD/YY) : 

        Application Status:         

Are you a National MOAA Member?

 MOAA Member Number:

Street Address ( Include Apt No. if Condo ):

City:

State: 

Zip Code:  
Phone:

    E-mail: 

If married, spouse’s first name:

Last name, if different than yours:

Regular Member: 

Active duty, retired, or former military officers are eligible for Regular membership.

Status:    

Rank:

Service:

Spouse: 

Spouse Rank:

Spouse Service:

Dues:     $20 per year;       5 years for $90       Active Duty and those 90 and older: free!

Note:  Free Members please put 00 in the Dues box and 00 in the Total Amount box (unless making a donation).

Surviving Spouse (spouse of deceased officer)

Rank of spouse of the Surviving Spouse:       
Dues:        $15 per year;        5 years for $60;         Those 90 and older: free!

Dues : $        Donations:   Scholarship $      Community Services $

Total Amount I am Submitting: $  
 There are 2 ways to pay. Check or Credit Card.  Indicate your payment Method: 

By Check:  Provide any comments and press the Submit button below.  Mail your check to: Hawaii Aloha Chapter MOAA, PO Box 201441, Honolulu, HI 96820, with a memo note on the check stating it is the Membership fee.  
With a Credit Card:  Remember the total amount you are paying.   Provide any comments and press the Submit button below.  You will be taken to a page where you will make your payment.

Questions?  Call Mark Webster at (808) 734-5994 or email markster96816@gmail.com
  
Comments or Information Request: