Detachment # _____________
Date _____________________
Transmittal # ______________
(Start new sequence on
July 1 each fiscal year).
Check #__________
NATIONAL DUES ONLY
R
__Renewal @20.00
N
__New Member @ 25.00
RAM __Renewal Associate@20.00
NAM __New Associate @25.00
RDM __Renewal Dual @20.00
NDM __New Dual @25.00
N* __March 1st-June 30th @15.00
NAM* __ March 1st-June 30th @15.00
NDM* __March 1st-June 30th @15.00
Life Member by age:
$________
$________
$________
$________
$________
$________
$________
L
$________
L
$________
L
L
__35 and under @ 500
__36 to 50 @ 400
__51 to 64 @ 300
__65 and over @ 200
Department Dues
Check #___________
Total $____________
❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋❋
Received at Department
Date:____________
Received at National HQ
(Date/Time Stamp)
TRANSMITTAL RETURN EMAIL
CITY
ST
ZIP + 4
DEPARTMENT PAYMASTER NAME
Shaded area are for National HQ use only.
© 2019 Marine Corps League, Inc.
For Official Marine Corps League use only.
All other use is prohibited.
MARINE CORPS LEAGUE
MEMBERSHIP DUES TRANSMITTAL & CHANGE NOTIFICATION FORM
FROM:Adjutant/Paymaster of
TO:
VIA:
National Adjutant/
Paymaster, 3619 Jefferson Davis Hwy Suite 115 Stafford VA 22554
Department Paymaster
PLEASE READ CAREFULLY
1. PLEASE TYPE OR PRINT NEATLY AND LEGIBLY.
2. Enclose separate dues payment checks; one (1) payable to National HQ, MCL, Inc. and one (1) payable to your
Department
3. Include Date of Birth for all NEW applicants (mandatory for PLMs).
4. STAPLE ORIGINAL-SIGNED APPLICATION FORMS TO TOP COPY (applications cannot be accepted without attached
application forms).
5.
MEMBER #
CODE(S)
HQ USE ONLY
LAST NAME (JR,etc).
FIRST
MI
PLM #
STREET ADDRESS (or PO BOX #)
CITY
ST
ZIP + 4
TELEPHONE NUMBER
E-MAIL ADDRESS
DATE OF BIRTH
MEMBER #
CODE(S)
HQ USE ONLY
LAST NAME (JR,etc).
FIRST
MI
PLM #
STREET ADDRESS (or PO BOX #)
CITY
ST
ZIP + 4
TELEPHONE NUMBER
E-MAIL ADDRESS
DATE OF BIRTH
MEMBER #
CODE(S)
HQ USE ONLY
LAST NAME (JR,etc).
FIRST
MI
PLM #
STREET ADDRESS (or PO BOX #)
CITY
ST
ZIP + 4
TELEPHONE NUMBER
E-MAIL ADDRESS
DA
TE OF BIRTH
MEMBER #
CODE(S)
HQ USE ONLY
FIRST
MI
PLM # STREET ADDRESS (or PO BOX #)
CITY
ST
ZIP + 4
TELEPHONE NUMBER
E-MAIL ADDRESS
DATE OF BIRTH
MEMBER #
CODE(S)
HQ USE ONLY
LAST NAME (JR,etc).
FIRST
MI
PLM #
STREET ADDRESS (or PO BOX #)
CITY
ST
ZIP + 4
TELEPHONE NUMBER
E-MAIL ADDRESS
DATE OF BIRTH
MEMBER # CODE(S)
HQ USE ONLY
LAST NAME (JR,etc).
FIRST
MI
PLM #
STREET ADDRESS (or PO BOX #)
CITY
ST
ZIP + 4
TELEPHONE NUMBER
E-MAIL ADDRESS
DETACHMENT PAYMASTER NAME/SIGANTURE
EMAIL
PHONE NUMBER
$________
$________
$_____________
________
*For members who join between March 1st and June 30th of each year.
________
DATE OF BIRTHDATE OF BIRTH
DATE OF BIRTH
You may use a supplemental spreadsheet if you have more than six members renewing at one time. Please include all
information needed from this form.
# of Years Paying
Prior Expiration
# of Years Paying
# of Years Paying
# of Years Paying
# of Years Paying
# of Years Paying
Prior Expiration
Prior Expiration
Prior Expiration
Prior Expiration
Prior Expiration
T= Transfer
R/I=Reinstate
COAN= Change of Address (NE
W)
COAO= Change of Address (OLD)
