Application for membership of ________________________________________

                                                                                               (Print Name)

                                 Marine Corps League Auxiliary, Inc.

I herewith make application for membership in the                                                               Date__________

________________________________________________________ Unit, Department of _________

Basis of Eligibility: (Circle one) Wife, Widow, Mother, Grandmother, Stepmother, Sister, Daughter, Granddaughter

Stepdaughter, Daughter-in-Law or Woman Marine (Former, Active or Reserves)

of __________________________, a Marine or FMF Corpsman (circle one), who does/does not (circle one) belong to

    (Name of Marine or FMF Corpsman)

____________________________ Detachment of the Marine Corps League.

    (Name of Detachment)

Mustering in date ________________ Place ______________________________________________

Mustering out date _______________ Place ______________________________________________

Deceased date __________________ Place ______________________________________________

Have you ever belonged to the Marine Corps League Auxiliary before? __________ (yes or no)

If so, what unit? ______________________________________________ Department of _________

Date last dues were paid? ____________ in __________________________________________ unit

Auxiliary Recruiter ___________________________            ______________________________

                                          (Current Auxiliary Member)                                          (Applicants Signature)

Eligibility checked: DD214 __________________               Address __________________________

       Honorable Discharge  __________________                            __________________________

                             Other  __________________                 Phone  __________________________

    Date Accepted by Unit  __________________                 Email   __________________________

                Rev. 8/05                             Original - Unit        1 Copy - National         1 Copy - Department