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ENROLLMENT APPLICATION MEMBERSHIP:
$20.00 per calendar year. |
PLEASE TYPE OR PRINT CLEARLY
INTERNATIONAL (Except Canada):
$30.00 per year U.S. Currency |
Last Name
_________________________________________________________
First Name
_________________________________________________________
Middle Name
_______________________________________________________
Spouse
___________________________________________________________
Street Address
_____________________________________________________
City ________________________________
State _______ Zip+Four _______
Telephone (____) ____-________
E-Mail_________________________________
Ships & Hull No.
____________________________________________________
Dates on Board
_____________________________________________________
Dates of Active Service
______________________________________________
Highest Rate/Rank Held
__________________________________________
Enrolled By 121A
MAKE CHECKS PAYABLE TO USNCSA and mail to:
Robert E. Partrick, Secretary USNCSA
2899 Newell Road
Camano Island, WA 98282-7090
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