"For Office Use Only"

N/R_______________ CH_________________C/S______________ RB________________

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Having served with or been attached to, or as a friend of the 4th Infantry Division, I hereby apply for membership and enclose a check for $15.00 for annual dues.

Make checks payable to: 4IDA

I am a Vietnam Veteran and I request placement in the 374th Radio Research (ASA) "Finder" Chapter

Unit: 374th Radio Research Company.

Years ___________________

Name: _________________________________________________________.

Address:__________________________________________________________.

Phone: (_____)______-_____________. Fax: (____)________-_____________.

Email Address: ____________________________________________________.

Spouse's name: _______________________________________________.

Print Application and mail to:

National 4th Infantry (IVY) Division Association

Rosemount, MN 55068