APPLICATION
 
AC-119 Gunship Association
Membership Application
or Renewal
 
 


Note: There is no charge to the surviving spouses of Life members.

Please clearly print all the information requested

I, __________________________________, hereby renew, or apply, for membership in the AC-119 Gunship Association and agree to abide with the By-Laws of the Association.

I served in combat with the (circle one) 71st SOS   17th SOS   18th SOS
from _____________________, 19______ to ___________________, 19_______, and from _____________________, 19______ to ___________________, 19_______, at:
(enter primary duty location)_________________________________ while performing as
(enter air or ground crew or other support position )________________________________________.

Associate membership: family members of those who served in or directly supported AC-119s or AC-47s, and others not meeting Regular Membership eligibity, may apply for Associate Membership.
I feel I am qualified to be an Associate Member due to the following: (Please explain)_____________________________________________________________________
_____________________________________________________________________

 

Address:_______________________________________________

City:___________________________________State:_______________

ZIP:____________ Phone:____________________________FAX:______________________________

Please include or update your email address (This is for association use only)

E-mail:_____________________________

_______________________________ __________________________
Signature                                                          Date

Enclosed is my check or money order in the amount of $20.00 for my Annual membership, or $119.00 for a Lifetime membership. If you would like to make an additional donation to the Association at the same time, it will be used wisely and greatly appreciated.

M
ail this form along with your Check or Money Order to:
Mike Drzyzga, Secretary • AC-119 Gunship Association • 37 Pecan Lane •Oak Ridge, NJ 07438-9165 • email: drzyzga513@hotmail.com

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