Fort Campbell Enlisted Spouses' Club"Friendships found on Eagle's Wings"

Enlisted Spouse's Club

Membership Form

Aug. 17, 2011–  Jun, 30, 2012

Date__________

Name___________________________________

Address_________________________________

Home Phone_____________________________

Cell Phone_______________________________

Email address____________________________

Birthday_________________________________

Anniversary Date_________________________

Spouse's Name___________________________

Spouse's Unit____________________________

Childres's Name/Age

_______________________________________

_______________________________________

_______________________________________

Special Interest or Hobbies_________________________________

Please circle any committees you are interested in participating in:

Hospitality        Publicity         Facebook         Welfare

Membership        Parliamentarian         Newsletter

Scholarship               Fundraising                  Other

Do you have any skills or talents you would be willing to share with our group? 

_______________________________________

_______________________________________

_______________________________________

I give my permission for my phone number and email address to be published in the Enlisted Spouses Contact roster: 

YES_____     NO_____

Signature_______________________________

Please use Paypal located on the Dues/Donations

to pay yearly dues or mail dues to:

ESC

POB 823

Fort Campbell,KY

42223