77th Artillery Regiment Association
Membership Application

Membership Type:

Highest Rank:

Battery(s) served:

Battalion(s)

Assigned:

Departed:

Section or position here:

Please provide the following contact information:

First name

Last name

Middle initial

  

Street address

Address (cont.)

City

State

Zip code

Country

Cell Phone

Home Phone

FAX Phone

E-mail

Your Web Page (If one)

Notes and comments:

When you click on Submit Membership Application, an email with all of your entered information is sent
to the Association Secretary for entry into the Association Member database. You should see a pop up
window appear that will confirm the information that was emailed. Please send your check or money
order for appropriate amount for dues and/or pin to the Association Secretary and he will confirm
receipt of your funds via email. Please mail to:

Copyright © 1997-2011 by 77th Artillery Regiment Association.  All rights reserved.
P. O. Box 8621
Jacksonville, Florida 32239-8621
Phone: (904) 236-4856 or
Toll free: 877-220-0393
Home Page: www.77fa.org

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Note: Donations to the Association are tax deductible as we are incorporated as a
registered (501) (C) (19) Military Association but Association DUES are not deductible.

Last Update - March 12, 2012