Third Recon Association
Membership Application

Print out a copy of this page, fill in all applicable spaces and mail Application/Donations to the appropriate address at the bottom of this page.

NAME (Last) _________________________________(First) _______________________(M.) ______


ADDRESS ____________________________________________________                                   

_____________________________________ ___________ _________________
                          City                            State        Zipcode

               
PHONE (_______) ______________________
         Area Code          Number              


DATE OF BIRTH ______/_______/___________
                   Month      Day        Year

Email Address: _____________________________________________

DATE(S) OF SERVICE WITH THIRD RECONNAISSANCE BATTALION (In combat) :

FROM ______________________    /  TO ______________________
(In which year do you want to be listed?)

RECON COMPANY SERVED IN _____________________ (If more than one, with which one do you wish to be listed?

CORPSMAN INDICATE YES ________

SERVICE NUMBER _____________________________________

AT LEAST TWO REFERENCES OF PEOPLE THAT YOU SERVED WITH IN COUNTRY.

____________________________________________///////////_______________________________________________

Copy of DD-214 MUST Accompany Application>>> I understand submission of this form, and once approved, I will become a member of the "3rd Recon Association, "I also give permission for my name, address, phone number,
to be published as part of the Association name and address listing". (For Bn Assoc. Use Only)

SIGNATURE __________________________________________________________ DATE _____________________

ATTENTION!!!(Mail Membership Form to:) ATTENTION!!!
Robert J. Vitiello
(Membership Director)
7111 142nd Ave. #102 
Largo, FL 33771 
(home) 727-724-4963 
(c
ell) 727-253-6967
umpav4@yahoo.com

____________________________________________________________________________________________________________

DONATION - $15

Submit Check Payable to: THIRD RECON ASSOCIATION, RVN

ATTENTION!!! Mail Donations to: ATTENTION!!!
John Winters
Treasurer
P.O.Box 38422
Pittsburg, Pa 15238

Email: Rockhaven1968@aol.com

H