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Marine Corps League Detachment 696

3223 Tangerine Way

Riverside CA 92506

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I hereby certify I have served as a U.S. Marine for more than 90 days, that the character of my service has been honorable, and if discharged, I am in receipt of an honorable discharge. By selecting 'Yes' herein, I hereby agree to provide proof of honorable discharge/service upon request.   Yes         No      

Branch of Service: USMC           USN            

 

Detachment: 696

Name:                                                                                                                

Address                                                                                                            

City:                                          State/Province:            Zip: Country:               

Phone:                                                        Fax:                                             

 

E-mail:                                                                                                              

Your E-mail address is important so that we may contact you concerning your application

Date of birth: (mm/dd/yy)       /         /           

Date of Enlistment/Commission: (mm/dd/yy)        /        /         

End of Service:      /     /                 Service # or SSN#                                            

Payment Method: Check/Money Order payable to MCL 696 in the amount of $37/yr.

Signature:                                                                                                          

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