APPLICATION FORM

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP83B00823R000200120009-1
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 16, 2016
• Document Release Date: April 17, 2000
• Sequence Number: 9
• Content Type: FORM

Approved For Release 2000/05/31 : CIA-RDP83B00823R000200120009-1
APPLICATION
Approved For Release 2000/05/31 : CIA-RDP83B00823R000200120009-1
 Approved For Releas 2000/05/31 : CIA-RDP83B008234000200120009-1
Association of Former Employees
of the
Central Intelligence Agency Inc.
full name)
retired from CIA on and apply for member-
date
ship in the Association of Former Employees of the Central Intelli-
gence Agency Inc.
Enclosed find check in the sum of $ for membership
fee and for anneal dues from to
I desire any correspondence sent to me to be addressed to my
home - office. (All'coyrespondence will be mailed in a plain
envelope with a P.O. Box return address.)
Home address and Telephone number
(Office address if any) and Telephone Number and occupation-)
Can you be listed in an Association Membership Directory?
Yes - No - Not sure. Can your name be in the files at National
headquarters? Yes - No - Not sure. If you have any doubt on this,
circle 'not sure' and we will check. Do not set out reason.
Do you desire to be listed in an Association Membership Directory
that contains no information identifying what the directory is?
Yes - No.
Approved For Release 2000/05/31 : CIA-RDP83B00823R000200120009-1