US Army Medical Command Japan

ASSOCIATION

"An Association Of Life Savers And Care Givers That Served In Post world War II"

Dear Sir:

I hereby apply for ACTIVE membership status to the USAMCJ Association. Elligibility requirements is "having served in a US Army Medical Facility in Japan/Okinawa between

1945 and the present as an officer (MD, MSC, or WO, enlisted, civilian, patient, or Japanese National." Dues are paid annually and the category of membership and the dues are listed in the next column. Associate Membership is available to children of active members. Spouses or companions of active member can apply for active membership and pay the dues of  regular active members. Personnel information, to include Membership Rosters will be used by the Association only and will not be provided to any outside source for any reason. Regular Members are requested to use similar discretion.

Please Check Type of Membership

  Regular 1 yr $10.00 :

  Regular 2 yrs $20.00:

   

  Associate 1 yr  $5.00 :

  Associate 2 yrs $10.00 :

 

 

Type in information below and send it to the address at bottom of page.

Name (last - first - mi)     Date of birth:    Place of birth:

Spouse:(Last (Maiden if applicable, first, middle):     Date of birth:    Place of birth:


Street # and Name                
City     State     Zip + 4 
Home Phone #    E-mail Address  

Office Phone #          

Cell Phone #              

If the unit you, your spouse, or parent served in is not listed enter it here

If retired from the military, please provide the following information:

  • Month/Year of Retirement

  • Grade/Rank at Retirement

  • Corps/Branch

If not a miltary retiree, please provide the following information: Month/Year you completed active service: ; Grade/Rank completed active service

Corps/Branch   Place of entry into service:   Basic Tng Unit / Location:

Advanced Tng Unit/Location   MOS:

 

Medical Facility you served with or were a patient in Japan.    Period you served

Position/Job Title   Your Unit:   Your Rank/Grade:

Total service activity, from basic until you were discharged from the service:

Military Awards and Honors Received:

 

Tell us a little about yourself. Current status (i.e. current employment, hobbies, volunteer services, type of employment, etc.

If retired, what type of work did you do? (Other than military)

 

Patients at any of the medical facilities also qualify

Print this Application, Then mail Check or Money Order To:

USAMCJ Association

Secretary & Treasurer

Attn: Charles W.S. Jezycki

1918 Shurtleff Avenue

Napa, CA 94559