AMSCA Membership Application

Please complete your membership details for AMSCA Membership. New members join for one year for $20. Membership renewals are available for 1 year or 3 years.

Username*

New Password*

Retype New Password *

First Name *

Last Name *

Email *

Phone

Maiden/Other Name

Address *

City *

State *

Zip *

Hide on Roster

Yes

Specialty (MOS)

OT (65A)

PT (65B)

DT (65C)

PA (65D)

Rank *

Date Entered Service

Dates of Service

Graduation Date

Date of Retirement/Separation *

Total Years of Service

Additional Comments

You may also include a donation when joining or renewing, if desired. AMSCA is a tax-exempt organization under the provisions of IRS code 501(c)(19). You may donate to:

Endowment for Scholarly Activities
Nannie Rudd Evans Scholarship
AMSCA Education Grant for Family Members
AMSCA General Fund
COL Betty Lambertson Memorial Newsletter Fund

Donation Amount

Donation Designation

Payment Information

Coupon

Price

Discount Amount

Gross Amount

Payment Method *

Paypal

Offline Payment

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

Security Code*

AMSCA Membership Application

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New User? Please register

Account Information

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