5^th Armored Division Incorporated

Application for Membership, 2012

New Membership Regular Member (Veteran)

Membership Renewal Widow (Widow of Veteran)

Associate Member

If paying for a year (or years) other than 2012, please indicate which year(s)

Please fill in all information, regardless of type of membership. If you are a relative of a veteran, please indicate that veteran’s unit of assignment.

Dues are $20.00 per year for U.S. and international members. Please make checks payable to 5^th Armored Division Association, Inc.

Mail check along with membership form to:

5^th Armored Division Association, Inc.

Bob Smithers, Treasurer

2843 SW 92^nd Terr.

Gainesville, FL 32608

NAME

ADDRESS

CITY STATE ZIP

COUNTRY AND POSTAL CODE (If other than USA)

HOME PHONE ( ) - .

DATE OF BIRTH / /

EMAIL ADDRESS

UNIT (BATTALION/REGIMENT) CO/BTRY/TRP

RELATION TO VETERAN (If applicable)

NOTES OR COMMENTS:

Purpose of the Association:

To preserve and strengthen comradeship among the one-time members of the 5^th Armored Division and to do all things necessary to accomplish this end.