Your on-line membership application is a two step process:

  1. Fill in and submit the "Membership Application Form" below.
  2. You will be taken to a payment page, where you will select your payment option using our secure PayPal service.

Membership application Form

(All entries except the email address are required)

Choose your preferred Membership:

Renewal :     Initial Enrollment:

    Choose a membership category: You must chose one of the four (4) categories below.

    Regular Membership:

  1. One year - $30 (With Printed Newsletter via USPS)
  2. One year - $20 (With electronic Newsletter via email)

    Surviving Spouse Membership (for Current or Surviving Spouse):

    Surviving Spouse membership costs are the same for printed and electronic newsletter, but you must chose one or the other. Thank you.

  3. One year - $20 (Printed)
  4. One year - $20 (Electronic)

If you wish to receive the newsletter electronically, you must fill in the email address below.

Name: Last , First   MI


City:   State:   ZIP: 

Rank/Grade:      Service:     



Email Address:

(Please provide your email address, if available.
This must be filled in to receive the newsletter electronically. )


What is your current military status


Are you a member of MOAA National?:


May we have your permission to publish this information in the Chapter Membership Directory (Not Date of Birth)?

(This directory and your email address are exclusively for the use of the chapter and will not be sold or used for any other purpose than chapter communications and/or board approved activity.)


Would you be interested in helping in chapter volunteer activity?

* Please enter the number 13 in the text box below -- this helps us eliminate Spam emails.