Membership Application

Welcome to the Western CT Military Officers Association!

Please fill out this form with as much detail as you can and SUBMIT. Be sure your email address is correct. Items with an *asterisk* are required.

WCMOA Membership Application

Use this form to formally submit your application to the Western CT Military Officers Association. You should also be a Member of our national organization MOAA (Military Officers Association of America) but this is not a requirement at this time.

Name*
First Middle Last
Rank*
The rank at which you retired or separated from the service.
Nickname/Callsign (opt)
We wanna know if your service buddies gave you cool name while you served!
Branch of Service*
Your branch of service when you retired or separated. (Pull Down Menu) If you served in more that one service, tell us that below under Military Experience.
Current Status*
(Pull Down Menu)
Years of Service*
Example: 1995 - 2002
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone Number*
Enter your primary contact number.
Additional Phone Number
Optional
Spouse's Name
MOAA National Member?*
- Yes
- No, but I will consider joining.
MOAA National Membership Number*
Enter your MOAA nimber or N/A if not a member yet.
Other Memberships
Such as military or veterans clubs, schools, charities, public service, community organizations.
Employment Status*
Employer & Position or Title*
Please tell us where you work and what position you hold. (Or N/A if Fully Retired)
Email*
Military Experience*
Units, installations, accomplishments, military schools, wartime campaigns & conflicts.
Civilian Experience*
Jobs held. Please list your curent employer, if applicable.
Hobbies/Pastimes*
Organization Support
Please list any desires and talents you have that could benefit our organization, such as public relations, charity voluteer experience, website design, recruiting, public speaking, etc.

Save and Continue Later

Dues – WCMOA has several different membership opportunities – Annual/Multi-year, and Lifetime:

Annual: $20 ($20/year)
3 Year: $50 ($16.66/year)
5 Year: $75 ($15/year)
LIFETIME: $200
Over 80+ and Auxiliary Members: FREE

To join our ranks, please fill out and send us a Membership Form.

WCMOA, PO Box 2145, Norwalk, CT 06852-2145

Or Contact Susan Monks, Membership Chair, on or +1-203-257-2089.

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