USS Enterprise (CVAN/CVN-65) Association

Membership Data Form

Please Print ALL Information Clearly

Last Name First Name Middle Initial
Nickname Spouse's Name Phone Number

Email __________________@_____________ Fax # ____________________________

Street Address
City
State Zip Code + 4
Years Aboard (19xx-19xx) Division Plankowner (Yes or No)
Additional Years Aboard Division Recruited By

Today's Date: Associate or Full Membership:Please circle one

Instructions

Please print the form andthen fill in all of the above information. Send this form along with a check or money order in the amount of $30 US to cover a one-time initiation fee of $15 and your first year's dues of $15

Make checks payable to: USS Enterprise (CVAN/CVN-65) Association

For all other inquires about joining the Association please contact our membership chairman:

USS Enterprise (CVAN/CVN-65) Association All Other Inquires
Secretary/Treasurer Membership Chairman
3545 Chamlin Dr 4 Summit Lane
Morris IL 60450-8454 Bethel CT 06801-3309
203-748-2460

All of the above information is for the sole use of the USS ENTERPRISE (CVAN/CVN-65) ASSOCIATION

Our organization conforms to the "Right to Privacy Act