Membership Application

Rank/Prefix: *

if Other, please specify: *

Name: *

First

Last

MI:

Suffix:

Award Nominee

MMA
BOM
SOM

Please check the box if you know you are being reviewed for an award.
Please note that 6 months minimum of active membership is required prior to receiving the BOM.

SCRA Chapter

Mailing Address: *

Address Line 1

Mailing Address Line 2

Address Line 2

City: *

State: *

Zip Code: *

Country: *

If physically located outside the Continental United States

Phone:

Primary Personal Email: *

Please use civilian email address for primary. You WILL NOT receive notifications or confirmation emails if you use your .mil as primary (to include reset password link)

Alternate Email (.mil):

Username: *

Password: *

Password

Confirm Password

Membership Length: *

1 Year - $35
3 Year - $70
Lifetime - $270

Please note E1-E6, O1, WO1, and GS1-GS9 receive discount on membership fee: $25 for 1 Year, $50 for 3 Years, and $175 for Lifetime Membership.
We will verify if you have had a previous membership. If this is a renewal you will not receive any of incentive options below as they are for new members.

Membership Length (Discounted): *

1 Year - $25
3 Year - $50
Lifetime - $175

Please note E1-E6, O1, WO1, and GS1-GS9 receive discount on membership fee: $25 for 1 Year, $50 for 3 Years, and $175 for Lifetime Membership.
We will verify if you have had a previous membership. If this is a renewal you will not receive any of incentive options below as they are for new members.

Membership Incentive Options - 1 Year (Select Item Image Below) *

1. $5 Off at SCRA Store
2. $10 Signal Museum Donation
3. Traditional Packet

Please choose which welcome gift you wish to receive as a new member.
-1. The Store Credit may be used on any purchase EXCLUDING awards. No minimum requirement. Shipping is always FREE.
-2. Museum donation will come from your membership dues at no additional cost to you.
-3. If selected, the traditional membership will be shipped to the address provided above. 1 Year is the SCRA challenge coin. Item is also available in the store.
Please note: if you had a previous membership with the SCRA, you will not receive any of the above gifts. We will verify previous membership status after form has been submitted and reactivate your previous membership.

Membership Incentive Options - 3 Year (Select Item Image Below) *

1. $10 Off at SCRA Store
2. $10 Signal Museum Donation
3. Traditional Packet

Please choose which welcome gift you wish to receive as a new member.
-1. The Store Credit may be used on any purchase EXCLUDING awards.. No minimum requirement. Shipping is always FREE.
-2. Museum donation will come from your membership dues at no additional cost to you.
-3. If selected, the traditional membership will be shipped to the address provided above. 3 Year is the SCRA challenge coin, a small lapel pin, and stylus pen. All items are available in the store.
Please note: if you had a previous membership with the SCRA, you will not receive any of the above gifts. We will verify previous membership status after form has been submitted and reactivate your previous membership.

Membership Incentive Options- Lifetime (Select Item Image Below) *

1. $20 Off at SCRA Store
2. $20 Signal Museum Donation
3. Traditional Packet

Please choose which welcome gift you wish to receive as a new member. Options 1 and 2 will come with a DIGITAL Lifetime membership certificate.
-1. The Store Credit may be used on any purchase EXCLUDING awards. No minimum requirement. Shipping is always FREE.
-2. Museum donation will come from your membership dues at no additional cost to you.
-3. If selected, the traditional membership will be shipped to the address provided above. All items are available in the store.
Lifetime packet consists of a PRINTED certificate, SCRA color challenge coin, a Life Member lapel pin, a stylus pen, and either a window decal or cell phone wallet.

Customize Traditional Packet (select item image below) *

Life Member Window Decal
Cell Phone Wallet

You will receive the Color Coin, Life Member lapel pin, and the stylus pen.
Please choose the window decal (4"x6") or cell phone wallet (sticks to the back of your phone) to complete your welcome gift.

Full Name for Certificate: *

Please enter your rank/prefix and name EXACTLY as you would like it to appear on your membership certificate.

Total

$0.00

Stripe Credit Card *

Card

Name on Card