Data Page
Member Data Form
Member ID # (9-digit)______________ Dept ______ Post # ________
Name ___________________________________________________
(First) (MI) (Last) (Suffix)
MEMBERSHIP RECORD CHANGE
__ Honorary Life Membership (Awarded by Post)
__ Paid-Up-For-Life Member (Purchased - for Post use only)
__ Deceased
New Address:
City: _________________ State: ___ Zip Code: _________
Check if applicable:
___Member holds the above elected office or appointment in the
Department or District.
Telephone #: _______________ E-Mail Address: ___________________
Date of Birth: _____________ Cont. Years Mbship: ______________
Month Day Year:(4-digit) ______________ # Years Paid Mbsp Year: ____
War Era: Mark the appropriate box with an "X."
(if more than one applies, please mark only the earliest War Era served)
__ 4/6/17 - 11/11/18 (WWI) D 12/7/41 - 12/31/46 (WWII) D 6/25/50 - 1/31/55 (Korea)
__ 2/28/61 - 5/7/75 (Vietnam) D 8/24/82 - 7/31/84 (Grenada/Lebanon)
__12/20/89 - 1/31/90 (Panama) D 8/2/90 - Cessation of hostilities as determined by U.S. Govt. (Persian Gulf)
Branch of Service: _ Air Force _Army _ Coast Guard _ Marines _ Navy
Member Transferring from: ______________________________
Member Transferring to: ________________________________
Department (Alpha code): ____________
Department (Alpha code): ____________
Former Post # : ______________
New Post # : ______________
Please print this page and complete the infomation spaces. Submit the completed form to American Legion Post 55.
