Membership Application

Please print this form and fill in the information
First Name	______________________________
Last Name	______________________________
Rate/Rank	______________________________
Street Address	______________________________
City	______________________________
State/Province	______________________________
Zip/Postal Code	______________________________
Country	______________________________
Home Phone	______________________________
Work Phone	______________________________
Email Address	______________________________
Webpage URL	______________________________

Tell Us About Your DE If you are joining as an Associate Member, please provide information about your husband's/family member's DE service
DE Name	______________________________
DE Number	______________________________
Dates In Service	______________________________

Did someone tell you about About/Encourage You to Join DESA? If yes, please tell us their name:

_____________________________________________

Please Select One of the following:

Yes, I want to join DESA
[ ] Member
[ ] Associate Member
[ ] Sustaining Member

Please include a check or money order
* One Year Membership $20.00
* Two Year Membership $38.00
* Three Year Membership $57.00
* Life Membership $150.00

[ ] I do not wish to join DESA at this time. Please send me more information and a free copy of DESANews

Mail this form and membership fee to:

DESA
P. O. Box 3448
DeLand, FL 32721-3448

Thank You and Welcome Aboard!