Application for Membership

W.A.R.P.

Beneficiary Name & Address:

Dept. Retired From:

Year:

Dues are $25.00 per year and make checks payable to W.A.R.P.

Please do not include any other fees, catalogue purchases etc.., with dues check... Strictly Dues!

and US mail to the address below"

W.A.R.P.

PO Box 168

Cheektowaga, NY 14225-0168

You will be contacted by Snail Mail or E-Mail as to your acceptance.

Your NYS Senate Dist. #:

Your NYS Assembly Dist. #:

Use the Print feature under the File Menu in your Browser to Print this form and mail it in, if you wish along with your dues.

D.O.B.:

State:

Zip:

Name:

Address:

E-Mail Address:

City:

Tel. No.: