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Last Name, First Name, Middle Initial  

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Maiden Name (if applicable)  

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Rank/Status (Active Duty, Retired, Guard, Reserve or Separated)  

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Dates of Service and/or Brief Service History
(EXAMPLE:  Sep 1971 - Dec 1991.  Enlisted: 71-74 Ellsworth AFB SD, 74 Myrtle Beach AFB SC, 74-77 Randolph AFB TX, 77-79 AECP Univ of Texas San Antonio.  Officer: 79-80 Nellis AFB NV, 80-81 Shemya AB AK, 81-84 Peterson AFB CO, 84-85 AFIT Wright-Patterson AFB OH, 85-91 Cheyenne Mountain AFS and Peterson AFB CO, 91 Eglin AFB FL) 

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Street Address (Do you want your address to appear in the online member directory?  [ Yes / No ]) 

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City, State, Zip Code (nine digit, please)  

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Telephone Number and Email Address (Do you want your telephone number [ Yes / No ] or email address [ Yes / No ] to appear in the online member directory?)  

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Husband's Name (if applicable)
 
The "Members Only" area of our website (www.afwoa.org) requires a user ID and password for access.  This area contains our newsletters and an online member directory.  Do you want a user ID and password issued for the "Members Only" area (email address required)?  [ Yes / No ]

Printing and postage costs continue to go up.  Do you want the quarterly newsletter mailed to you, or would you prefer to receive it via email?  [ Mail / Email ]