AIR FORCE RETIRED OFFICERS COMMUNITY WASHINGTON, D.C.

 
 
Date:
Preliminary Application For Membership
I/We hereby apply for membership in AFROC-Washington, D.C.
Note: Please complete all items. Use N/A (Not Applicable) it appropriate.
OFFICER:
1. NAME
2. RANK
3. SEX
4. BRANCH OF SERVICE
5. HOME PHONE
6. ADDRESS
7. BIRTHDATE
8. SSN
10. DATE OF RETIREMENT
9. ACTIVE OR RETIRED
11. TOTAL YEARS OF ACTIVE SERVICE WHEN RETIRED (OR DECEASED)
12. ENTITLED TO RETIREMENT PAY?
Note: Officer section should also be filled in where possible by Widows and Widowers.
1. NAME
HOMEPHONE
2. DATE OF BIRTH
SOCIAL SECURITY NUMBER
3. ADDRESS:
4. MILITARY I.D. EXPIRATION DATE
5. FOR WIDOW(ER)S: ALSO COMPLETE OFFICER SECTION FOR DECEASED SPOUSE
(A) MILITARY SPOUSE WAS:
(B) DID YOU REMARRY:
(C) DATE SPOUSE DECEASED:
I/We understand that we will be assigned a priority number for placement on the Priority List for AFROC residency upon
receipt and approval of this application and check made payable to AFROC-Washington, D.C., in the amount of $1,000.00.
I/We also understand that we may withdraw from the Priority List at any time, and the full amount of the above deposit, without interest, will be returned on 30 days notice.
Signature(s) of Applicant(s):
Emergency Contact
Name:
Address:
Phone:
OFFICE USE ONLY:
PRIORITY NUMBER:
APPROVED:
CITY:
STATE:
ZIP:
CITY:
STATE:
ZIP:
SPOUSE:
WIDOW:
WIDOWER: