38th Parallel Medical Society
MEMBERSHIP ENROLLMENT FORM
Please enroll me as a member in the 38th Parallel Medical Society.
Enclosed is my fee of $20.00 (payment may be made by check or money
order). Check should be made payable to: Treasurer, 38th Parallel Medical
Society.
NAME: ___________________________________________________________
(LAST) (FIRST) (MIDDLE)
RANK/CORPS: __________ BRANCH: _____________
COMPLETE MAILING ADDRESS:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_________
DUTY LOCATION (INSTALLATION): __________________________________
DUTY PHONE: ____________________________________________________
SIGNATURE: ____________________________ DATE: _________________
NAME (Write exactly as you wish it to appear on your certificate):
__________________________________________________________________
E-Mail Address:_____________________________________________________
SEND MEMBERSHIP FORM AND PAYMENT TO, OR PAY AT THE 38TH
PARALLEL MEDICAL SOCIETY:
Jeffery F. Rimmer
Treasurer, 38th Parallel Medical Society
Unit #15281
Box 561
APO AP 96205