Join the Association

All current members are encouraged to renew their membership and recruit new members. Remember, you are this association! Also, please visit our
sponsors. We couldn’t support the association without them.
Having served with the 4th Infantry Regiment, I hereby apply for membership or renewal and enclosed are my dues. (Membership is also open to
family members and supporters of the association as Tribal Society and Heritage Society members.)
NEW ____ RENEWAL____
Unit: Company: ___ Battalion_____: From: dd/mm/yy __________To: dd/mm/yy _____________
Name: _______________________________ Nickname:______________ Spouse: _____________
Address: _________________________________________________________________________
City: ___________________________________________ State: ___________ Zip: ____________
Phone: (______)_______-______________ AGE: _______ Birthdate: ________________________
Email Address: ____________________________________________________________________
MAY we provide your contact information to other members of this Association? YES___ NO___
MAY we list your unit, name and dates of service on our website roster? YES___ NO___
MAY we list your email address on our website roster? YES____ NO ____
NOTE: Your address and phone number will NOT be listed on the website roster.
See Below For Dues Information:
Veteran Membership Dues ($24.00 per year)* ___________
Family Member “Tribal Society” Dues ($14.00 per year)** ___________
Heritage Society Dues ($34.00 per year)** ___________
Lifetime Veteran Membership ($240.00)* ___________
Lifetime “Tribal” Membership ($140.00)** ___________
Lifetime “Heritage” Membership ($340.00) ___________
Corporate Sponsorship*** ____________
Donation for Wounded Warrior Fund ___________
Donation for Memorial Fund ___________
Total Enclosed: ___________
Make checks payable to: 4th Infantry Regiment Veterans’ Association.
Mail to:
Richard Wideman
President
4th Infantry Regiment Veterans’ Association
P.O. Box 3773
Fort Polk, LA 71459

Fourth Infantry Regiment