Membership Application - Commissioned Officers Association of the
APPLICATION FOR NEW MEMBERS ONLY
8201 Corporate Drive, Suite 200, Landover, MD 20785
Previous/Current members, please visit www.coausphs.org to renew
membership dues and update personal profile via the Members Only site.
*First Name, MI:
ACTIVE DUTY STATUS
* Birthdate (MM-DD-YYYY)
* Active Duty Date (MM-DD-YYYY)
Retirement Date (MM-DD-YYYY)
PLACE AN "X" NEXT TO APPLICABLE NATIONAL DUES AMOUNT....
ACTIVE - Grade 03 & Below
ACTIVE - Grade 04 & Above
RETIRED -Grade 03 & Below
Age 64 & Under
RETIRED - Grade 04 & Above
Age 64 & Under
RETIRED - Age 65 & Above
FORMER COMMISSIONED OFFICER
MEMBER DUES INFORMATION - COA INVOICES DUES ON A FISCAL YEAR,
JULY 1 THRU JUNE 30. COA DOES NOT
PRO-RATE MEMBER DUES.
TOTAL NATIONAL DUES
BRANCH/ LOCAL DUES
PLEASE ADD MY
- Frontline is available to COA Members @
*Total payment must reflect both National and local dues, if affiliating with a local branch.
PAYMENT OPTIONS: (SELECT ONLY ONE OPTION)
If selecting payment by check, please print a copy of the application and include with payment.
Check enclosed, made payable to COA.
I authorize COA to charge the selected card for the total noted above.
Card Number :
Submit by E-mail
39 & Under
71 & Above
Payment may be made in full or in three installments within COA's current fiscal year.
If affiliating with a local branch, applicable dues are invoiced yearly.
COA does not pro-rate annual National dues or Life Member dues.