5th Armored Division Association, Inc.
2843 SW 92nd Terrace
Gainesville, FL 32608

Email: smithersb@yahoo.com

Application for Membership Or Dues Report

[_____] NEW [_____] Renew 2011 [_____] Reinstate

I wish to join the 5th Armored Division Association, Inc.
I understand the dues are $20.00 per year  [Overseas Associate Dues $50]
and as along as I am A Member in good standing, I will receive the
quarterly issues of "The Victory Division News"
published in March, June, September and December.

NAME:_______________________________________________________________

ADDRESS:____________________________________________________________

_____________________________________________________________

CITY:_________________________________________________________________

STATE:___________________ ZIP:__________________

PHONE:_________/_____________/_______________

E-MAIL _______________________________________________

Company___________________ Battalion________________________

Birthdate;   Day:______________/Month:_________________/ Year:___________

ARMY, Buddies, etc.:__________________________________________________

_______________________________________________________________________

FAMILY, Wife, Hobby, etc.:_____________________________________________

_______________________________________________________________________

_______________________________________________________________________

Make $20.00 DUES checks payable to:  [Overseas Associate Dues $50]
5th Armored Division Association, Inc.

Send to: Bob Smithers
              2843 SW 92nd Terrace
              Gainesville, FL 32608