Combat Medic
Association

Dear Sir
Pleas accept my application for the Combat Medic Association. I have been awarded the CMB and/or qualify under another listed requirement.  I will mail a copy of my DD214 or orders to serve as verification of my eligibility. I will also send a check or money order to pay for my selected category of membership.   I understand that REGULAR Membership will expire 31 December of last year paid.   
                                                                 Please Check Type of Membership
1 Year Regular  $35.00  3 Year Regular  $75.00 Life  $125.00

Name (last - first - mi)
Street # and Name             
                             City     State     Zip + 4 
Home Phone #              E-mail Address  

  I Have Been Awarded   (check all that apply);     CMB          18D          EFMB           Citation for Valor      POW Medal
  I  Am Serving or Have Served As;        Dust Off Team      Physician Assistant       Presently on Active Duty     
  Unit you served with when you earned the above awards;


Print This Application, Then mail ,verification(DD214 or Orders) of award, and check or money order to:
Combat Medic Association
 Post Office Box 73806
Fort Bragg NC 28307

 For Official Use Only

Date Approved Type Member # Amount Pd Remarks
  Reg / Life      

Recommended By : ___________________________

Approved By : _____________________________________   Member # ____________
                                     Member Board of Directors                                                                   Regular  /  Life

Additional Remarks: