NCNGA Membership Application Please type (or print clearly) Name: __________________________________________________________________ Address: ________________________________________________________________ City: _________________________________ State: ___________ Zip: _____________ Unit: _________________________________________________ Social Security Number ________ - ________ - ____________ E-mail Address: ____________________________________________ ______ I prefer to receive my magazine via e-mail ************************************************************************
Membership Type (please check one): ____ Annual ($15)
(1 JAN – 31 DEC)
____ Life ($250) ____ *Life dues installment plan option (*Life dues may be paid in quarterly installments of $62.50 each.
The first installment of $62.50 must accompany your application. Life dues (and any portion paid towards life membership) are non-refundable.)
Credit Card Payment: _____ MasterCard _____ Visa (If paying by credit card, a $3 processing fee will be added to your total.) Name on Card: ___________________________________________________ Card No. ________________________________________________________ Expiration Date: _______________ 3-digit security code ______________ (on back of card) Signature: ________________________________________________________ Return the completed application and dues payment (check/money order/credit card - please do NOT send cash) to: NC National Guard Association, 7410 Chapel Hill Road, Raleigh, NC 27607-5047