GSW Application Form
To join GSW, print this form, fill it out, enclose a check or money order made out to Gold Star Wives of America, Inc., and send it to:
New Member Application
Gold Star Wives of America, Inc.
PO BOX 361986
Birmingham, AL 35236
Dues Payment
$25.00 for One Year
$50.00 for Two Years
Or Lifetime Membership:
$500.00 Age 40 and Under
$400.00 Ages 41-55
$350.00 Ages 56-69
$200.00 Ages 70 and Over
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Member's Last Name First Name MI Date of Birth
Address
City ST Zip
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Phone E-Mail Address
Spouse's Last Name First Name MI
Spouse's Branch of Service
Army
Navy
Marines
Air Force
Coast Guard
Rank / Rate
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Date of Death Place of Death ST
Cause of Death
Required to establish membership eligibility:
Active Duty
Service-connected Disability
___________________________________ __________________
Signature Date
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$25.00
for One Year
