| Annual Membership Fee: $20.00 PLEASE NOTE: Associate Members do not pay a fee. Please make check payable to: BSMA Chapter #1 and send to BSMA, PO Box 426, Bloomfield, NY 14469. |
Please check one of the following:
Membership: I am a New Member: ___
I am a Transfer Member ___ From Chapter #, City and State __________________
I am a member renewing for year: ______________
Please check one of the following:
I am a: ___Mother ___Dad ____Associate
I am a Gold Star Mother or DAD __yes __no
Applicant's Full Name: __________________________________________________
Address: (include your city, state & zip)Email: _________________________________________________________
Home Phone: (REQUIRED) _______________________ Cell(optional):__________________
Please fill out the following for each military/veteran child. Use reverse side if necessary:
| Name | M/F | Service Branch | DOB (Optional) |
Current Address |
FOR OUR SUNSHINE CLUB:
Your Birthday (Optional):
Your Wedding Anniversary (Optional):
LOYALTY OATH: I do solemnly swear that I am not a Communist, Fascist, or Terrorist. I do not advocate nor am I a member of any organization that advocates the overthrow of the government of the United States by force or violence or other unconstitutional means or seeking by force or violence to deny any person their rights under the Constitution of the United States. I do further swear that I will not so advocate nor will I become a member of such an organization during the period I am a member of the Military Mothers of New York #1. I will support and defend the Constitution of the United States against all enemies foreign or domestic; that I will bear true faith and allegiance to the same that I sign this oath freely, without any mental reservation or purpose of evasion, so help me God.
Signature:__________________________________________Date:______________________