Application for Membership in
The American Legion Post 979
4501 Airport Rd Bartonville, Il 61607
Please fill in completely and submit with a COPY of your DD 214
Note: Some of this info is on the DD 214. However, in most cases it is very time consuming to decipher the many variations of the DD-214. You assistance is appreciated.
Name____________________________________________________________
First
Middle
Last
Address___________________________________________________________
________________________________________________________________________
City
State
Zip
Telephone(___) - _______ (___)-_________
(___)-________ (___)-_________
Home
Business
Cell
Fax
Occupation____________________________________________________________
Military_____________ _____________ _____________
_____________
Branch
Rank
Rate/MOS
Serial No.
____/____/____
____/____/____ ________o HON _______________
Date of Entry
Date Discharge Type Discharge
Era
_____________________________
_____________ _____________
Service Disability
C. Number Blood Type
____/____/____ _____________ _________o CA
_______o USA
Date of Birth City
State
Country
_____________________________ _____________ _____________
Next of Kin
Relationship
No. Dependents
___________________________________________________________o Same
Next of Kin Address
DD-214 included
o Yes
___________________________________ ____/____/____
Signature of Applicant Date
Email: __________________@_________________________
We, the undersigned members of this Post 979, do hereby certify that we have personally examined this applicant's Honorable discharge and have verified their qualifications for membership in American Legion
Post 979.
1.________________________________________2. __________________________________