MUSLIM AMERICAN VETERANS ASSOCIATION POST 1 MEMBERSHIP FORM
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Name (Please Print) Today’s Date
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Street Address
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City State Zip Code
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Home Phone Cell Phone Work Phone
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E-Mail Address
* The information requested below is optional but recommended
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Legal name(s) used while on active duty or reserve if different from present name
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Branch of service Tenure of military service (ex: 1972 -1976)
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Highest rank held Type of discharge
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Field of work most interested in (administration, technology, construction, medical, clerical, etc..)
Briefly explain any medical condition that you have and feel we should be aware of:
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