Online Membership Form Please fill out the membership form below and submit it. Fields with * are required. If you receive an error after submission, please check that all fields with * are filled in or contact firstname.lastname@example.org. Application Information Your First Name* Your Last Name* Your Email* Your Phone Number* (XXX) XXX-XXXX Join or renew?* JoinRenew Your Military Information Are you yourself a member of the military?* (Your spouse military information can be entered later.) NoYes Your Military Status ---ActiveRetired Your Military Branch ---ArmyNavyAir ForceMarine CorpsCoast GuardPublic Health ServiceOther Your Pay Grade ---O-1O-2O-3O-4O-5O-6O-7O-8O-9O-10 Spouse/Partner Information Please provide the following information about your spouse or partner. Spouse First Name* Spouse Last Name* Spouse Military Status* ActiveRetiredCivilian Spouse Military Branch* ArmyNavyAir ForceMarine CorpsCoast GuardPublic Health ServiceOther Spouse Pay Grade ---O-1O-2O-3O-4O-5O-6O-7O-8O-9O-10 Spouse Duty Station* WRNMMCUSUHSBUMEDFort BelvoirOther (If 'Other', please specify) Spouse Department* Examples: "GME", "OB/GYN", "Navy Marine Corps Public Health Center", etc. Spouse Job Title/Area of Responsibility* Examples: "Student (please indicate year)", "Intern", "Resident", "Attending", "Base Command" Additional Information Home Address* Home Address Line 2 City* State* Zip* Interests BenevolencePlaydatesSocial GatheringsBook ClubCraft ClubBooks4KidsFisher HouseHospitalityVolunteeringDeployment SupportUSU Student SpouseOther Other interests Complete the application When you click Submit, you will be automatically redirected to our payment page.