DSSAA Membership Application

Complete this secure online application to send your membership information to DSSAA. This page will lead you to the next step to pay the dues by MasterCard or Visa. After the payment is processed, we will send a confirmation email to you.

Please note: this page and the credit card payment page are located on an ordinary server, therefore you will not see any indication that the form is secure. However, the forms are sent through Hushmail's server and the encrypted application information is sent to a secure email address, so your personal information is safe!

If you would rather send in your membership application by snail-mail, click here to open a printable version of this application.

Click here to view the current membership fees.
Please fill in this application as completely as possible. Fields marked with an asterisk (*) are required. Click "Submit" at the bottom of the page to send your application to DSSAA Headquarters.
* First Name: * Last Name :

*Home Address:

Number and Street:

City: State:

Zip Code:

Home Phone:

* Home E-mail:

Business Address:

Number and Street:

City: State:

Zip Code:

Business Phone:

Business E-mail:

Children's Names (one per space):

* Your Position:

Office Symbol or Business Name:

*BSAC#

and/or EOD:

Emergency Contact (spouse, relative, friend, etc.):

Name:

Phone:

Email:

Please check the appropriate box:

Active Duty S/A

Retired S/A (Dates of employment: )

Former S/A (Dates of employment: )

Other (Courier, SEO, etc.):

Do you wish to be listed in the online membership directory (name, city/state, home phone, and email addresses only) YES NO

May we release your name and address to the DS Foundation? YES NO

Use this space to include additional information or comments:
Click "Submit" to send your application to DSSAA Headquarters!