National Order of Trench Rats


DATE: __________________                 LIFE MEMBER NUMBER: ___________________________

MEMBER NAME:___________________________________________________                                

ADDRESS: ________________________________________________________                                 

CITY: _________________________________________  STATE: _________  ZIP:_______________ 

FROM DUGOUT: _________________________   TO DUGOUT: ____________________________

MEMBER’S SIGNATURE: _____________________________________________________________

SIGNATURE OF RECEIVING DUGOUT’S REG:  ________________________________________ 

                                      After brother/sister has been accepted by the new                           
            Dugout, send this form to Imperial Headquarters at:
             National Order of Trench Rats Imperial headquarters
P.O. Box 500208
Malabar, FL 32950