CGMA 43 | Active Duty Contribution Form

Coast Guard
Mutual Assistance

Active Duty - Contribution
Allotment Authorization

Fields with an * are required.

First Name *

Middle Initial

Last Name *

Suffix

Employee ID *

Home Address *

Address 2

City *

State *

Zip Code *

Personal Email *

Rank/Rate/Grade

OPFAC #

Current Duty Station *

YES! I want to help Coast Guard families in their time of need!

(Optional) I have an existing allotment of:

Deduct this amount from my monthly USCG pay (half will be deducted each pay period):

How has CGMA helped you or your family? Where were you when CGMA made a difference for you or a shipmate? What does CGMA mean to you?

Share your story!

Authorization to process and submit your allotment request

I hereby authorize this allotment to CGMA be taken from my Coast Guard Pay. I understand that it will remain in effect until I request that it be changed or stopped.

Or submit to CGMA Headquarters via one of the following:
Fax: (703) 875-0344
Mail: Coast Guard Mutual Assistance, 1005 N. Glebe Rd, Suite 220, Arlington, VA 22201
Printable version: Print then take a photo or scan this form and Email to Donations@cgmahq.org Printable PDF > >

Thank you for your tax-deductible contribution to Coast Guard Mutual Assistance!