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Forms
WESTERN BUFFALO SOLDIERS ASSOCIATION, INC.

You may obtain forms by requesting them by e-mail. This is what the Application form look like. You may try saving it as an Word file, then try printing it. It may work.

WESTERN BUFFALO SOLDIERS ASSOCIATION, INC.

1201 E. MICHIGAN ST. TUCSON, ARIZONA 85714

PHONE/FAX: 520-294-4402

    Membership Application and Contribution Form

Renewal: _____ New Member: _____ Contribution: _____ Group or Organization: _____

Date: __________ if renewing, please give current membership number if known __________

Name of Group or Organization: _________________________________________________

First Name: ________________________________________________ Contact Person _____

Last:          ________________________________________________

Address:     ________________________________________________________________________

City:   ________________________________ State: __________Zip Code:__________

Phone Number ___________________ Gender   (M) or (F) _____

E-mail Address ________________________________________________ 

Are you 18 years old or older? ____ Must be at least 18 to become a Full Member.

Are you 55 or older? ____ Full Members only          are you retired? ____ Full Members only

MOTTO: Restoring, Reconstructing and Reliving the Past, so that it may be enjoyed in the Present, ensuring that it will be remembered in the Future.

Please make checks payable to WESTERN BSA, INC.

Annual Membership                                                                          Your Individual Contribution

Type of Membership                                                                                   Level of Contributions

____Full Member$100.00                                                                        Private... $100.00 ____

____Associate... .. $50.00                                                                         Corporal.... $250.00 ____

____Renewal ... $50.00                                                                          Sergeant... $400.00 ____

                                                                                                                   Sergeant major.. $750.00 ____

                                                                                                                   Lieutenant... $1500.00 ____

____Contribution       Amount: __________                                               Captain..... $2500.00____

  All contributions are tax deductible minus any benefits                          Major..............$5000.00 ____

  you might receive.                                                                       Lieutenant Colonel....$10,000.00 ____

                                                                                                                    Colonel.....$15,000.00 ____

 All New Members are required to read Articles of Incorporation and the Bylaws. I have read the Articles of Incorporation and bylaws ____. My answers are true and complete. I understand that if I am accepted, any false or incomplete statements in this application will be grounds for immediate termination of membership.

Date: _________ Amount enclosed _________ Applicant's Signature: _________________________

 

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                          OPTIONAL INFORMATION (Full Members only)

(This information will be used to help us see where your skills can best be used to help the Association) for groups or Organizations this section must be filled out by the contact or spoke person.

                                                        Education

High School

                Name of School: ________________________________________________________

                Location: ______________________________________________________________

                Number of years attended: _____________

                Did you graduate? __________ What year did you graduate? ____________

Technical School

                Name of School: ________________________________________________________

                Location: ______________________________________________________________

                Number of years attended: _____________

                Did you graduate? __________ What year did you graduate? ____________

College and Post Graduate

                Name of School: ________________________________________________________

                Location: ______________________________________________________________

                Number of years attended: _____________

                Did you graduate? __________ What year did you graduate? ____________

                What degree? __________________________________________________________

                Name of School: ________________________________________________________

                Location: ______________________________________________________________

                Number of years attended: _____________

                Did you graduate? __________  What year did you graduate? ____________

                What degree? ___________________________________________________________

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Employment History      (Must be completed by Full Members)

Beginning with your most recent employment and working back in time, please give the following information:  For groups or Organizations this section must be filled out by the contact or spoke person.

Employer: _______________________________________________________________

Address:   _______________________________________________________________

Job Title: _______________________________________________________________

Duties:     _______________________________________________________________

Dates of Employment: __________________

 

Employer: _______________________________________________________________

Address:   _______________________________________________________________

Job Title: _______________________________________________________________

Duties:     _______________________________________________________________

Dates of Employment: _________________

 

Employer: ______________________________________________________________

Address:   ______________________________________________________________

Job Title: ______________________________________________________________

Duties:      ______________________________________________________________

Dates of Employment: __________________

 

 

 

 

 

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Emergency Contact (Full Members Only) for groups or Organizations this section must be filled out by the contact or spoke person.

Please provide the names of two persons who may be contacted in case of an emergency.

Name: __________________________________________________________________

Address: ________________________________________________________________

Telephone no.: ______________________

Relationship: __________________________

 

Name: _________________________________________________________________

Address: _______________________________________________________________

Telephone no.: ______________________

Relationship: __________________________

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Additional information

Please tell us about any other training, education, skills or achievements that you feel can be an asset to the Association.

________________________________________________________________________________

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Statement of Medical Health

Do have any health problems that would prevent you from riding horses or participating in other physical activities?   Yes _____ No _____ if your answer was Yes you may be ask for more details at a later date.

Medical Problem: __________________________________________________________________

My answers are true and complete. I understand that if I am accepted, any false or incomplete statements in this application will be grounds for immediate termination of membership.

Date: _______________________

Applicant's Signature: _________________________________________________

For forms or any other information please e-mail us at westernbsa@juno.com. We will gladly e-mail them to you.