Register Application for membership Dieppe-Vets PO Box 463, Station Main, Moncton NB E1C 8L9 E-Mail: [email protected] Web: www.dieppe-vets.ca FILL ALL SECTIONS PLEASE Name Name First First Last Last Address City/Town Postal Code Phone/Cellular Emergency contact Email Date of birth (Day/Mo/Year) Are you a member of any other organization (Yes/No/Name) Uniformed Service (if applicable) Regular MilitaryReserve militaryCIC MilitaryRCMPOther (Paramedic, Police, etc) Regimental/Service number Element NavyArmyAir ForceOther Decorations, medals, etc Enlistment date Honorable discharge date Signature of applicant Sponsored by Member (if applicable) Captcha Your email address Text If you are human, leave this field blank. Submit Δ
