Application For Officers ’Club Membership
(Please print, fill out, and mail to Officers' Club of Connecticut, National Guard Armory, 360 Broad Street, Hartford, CT, 06105-3795)

NAME     _________________________________________________

STREET  ___________________________  PHONE (____)__________

TOWN    ______________________ STATE ________ ZIP________

I HEREBY APPLY FOR MEMBERSHIP IN THE OFFICERS’ CLUB OF CONNECTICUT (CHECK ONE)

OFFICER MEMBER (RANK______, BRANCH_______)

ASSOCIATE MEMBER

ENCLOSED IS MY MEMBERSHIP FEE OF $75.00