USS Enterprise (CVAN/CVN-65) Association
Membership Data Form
| Fees |
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Type in information in appropriate boxes then print and mail with dues
| Last Name | First Name |
Middle Initial |
| Street Address |
| City | State | Zip Code + 4 |
| Phone Number | Fax |
Cell Phone |
If current member Membership # |
| Nickname | Spouse's Name |
| Years Aboard (19xx-19xx) | Division | Plankowner (Yes) Check box |
| Additional Years Aboard | Division | Recruited By |
| Do you wish to be added to our list for on-line
newsletters Check box
I plan on attending our next reunion for times and dates Our Website |
Today's Date: | Check box Full Membership Associate Member (never servered aboard the ship) |
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If mailing this form Make checks payable to: USS Enterprise association
Our organization conforms to the "Right to Privacy Act