USS Enterprise (CVAN/CVN-65) Association

Membership Data Form

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
Email


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
Home

 Today's Date:

 Check box
Full Membership

Associate Member (never servered aboard the ship)

If mailing this form Make checks payable to: USS Enterprise association

Fees and mailing address

Our organization conforms to the "Right to Privacy Act