NGAA-WEST MEMBERSHIP APPLICATION

Name

Retirement date:
Transfer date:
Organization from which retired or transerred/current employment(NGA,NIMA,DMA,other):
Last position held:
Professional affilation(s):
Post-retirement work experience/position held,with whom:

Last Name:
First Name:
Middle Initial:
Preferred Name(optional):
In the case where both spouses are eligible in his/her own right, only one fee will be assessed(and a joint listing will be used)
If separate listing is desired,and one spouse is already a member,the other may join at no addition fee
Check if spouse a current/former employee of NGA or predecessor organization
Spouse Retirement date:
Check if spouse a member NGAA-West Check if spouse a member NGAA-East

Are You a Credit Union Member ? (check if you are)

*The Arsenal Credit Union will reimburse $40.00 to the account of a new lifetime membership applicant who has been an ACU member

in good standing a minimum of one year,provided that the applicant's retirement occurred after Janyinguary 31,2013.

if you qualify,please provide your ACU account number.After we have processed your application, we will notify ACU of your membership

ACU will then credit your account with $40.00

ACU account number:

Note: Participation in any Chapter's information/social functions is reciprocal with East group. Voting privileges exist only to

dues paying members. A Chapter directory is also available to dues paying members. General information ,including newsletters,is in public domain

on the chapter web site http://www.ngaawest.org
Note: Let us know activities you are interested in: volunteering, socializing,travel, teaching,gardening,playing cards,etc.

What would you like us to provide to help keep you happy and active, both physically and mentally?
Interested in:

Comments: max char. length is 100

Application Date: