Membership Invitation
Membership is effective on the date application is approved and processed at AMRA.
AMRA cannot process your application until you have completed the payment section and provided proof of eligibility. You will find information as to what constitutes proof within the application below.
1 Surviving spouse should apply for membership in his/her own name, not in the deceased spouse's name.
* Designates required field.
*Type of Membership: All prices are in U.S. funds.
*Eligibility: Membership must be in Military Member's Name unless applicant is their surviving spouse.1
*First Name:
MI
*Last Name:
*International:
*Mailing Address:
*City:
*State (Choose INT for International):
*Zip/Postal Code:
*County:
*Country:
*Year of Birth: (yyyy)
*Spouse's Name: (type none for no spouse)
*Phone #: Include area code xxx-xxx-xxxx
*Email Address:
*Combat Vet
*Branch RETIRED From:
Nearest military installation:
*Proof of Eligibility: Proof of eligibility must accompany application. Select ONE from the list below (redact or blackout Social Security numbers) and submit to National Headquarters.
RETIRED:
DD214
RETIREMENT ORDERS OR CERTIFICATE
MILITARY RETIREE ID (copy of front and back)
MEDICAL RETIREMENT DOCUMENT
DISABLED:
DISABILITY RATING DOCUMENT INDICATING DISABLED, T & P
SURVIVING SPOUSE:
DIC Documents or CHAMPVA ID Card
*I will send my proof of eligibility via: Military ID cards cannot be faxed due to the security features that render it illegible.
U. S. Mail
Fax to 518-324-5204
Email to info@amra1973.org
I wish to be:
How did you initially hear about us?
*TRICARE/CHAMPVA supplemental insurance with Association & Society Insurance Corporation (ASI)?
Optional - for statistical purposes only
Career service dates from (Year only)
to
.
Rank at Retirement:
Skills/Expertise:
Hobbies and Interests:
Recruited by: (Member Name and Member #, if available)
Comments: (255 max characters)
From time to time AMRA shares its mailing list with vendors who offer products or services of
value to retirees
I do not wish to receive vendor offers.
|
