USNCSA membership form

             ENROLLMENT APPLICATION                                                    PLEASE PRINT CLEARLY

MEMBERSHIP: $25.00 per calendar year.
INTERNATIONAL MEMBERS (Except Canada): $30.00 per year U.S. Currency
LIFE MEMBERSHIP: Age 80 or older $100, 70-80 $200, 60-70 $300, 50-60 $400, Under 50 $500 Birthday____________

   [ ] NEW MEMBER [ ] ASSOCIATE MEMBER   [ ] WIDOW [ ] RENEWAL

Name____________________________________________________ Spouse_________________________
                Last                                First                                 Middle   Address__________________________________________________Telephone(___)_____________________

City__________________________________________________State________Zip+Four____________

Work Tel:                                        FAX:                                  e.mail

Ship & Hull No.     Dates Served Aboard/Division

__________________________________________________________________________________________

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Dates of Active Service                                                                 Highest Rank/Rate Held

Enrolled By                                              Address                                                    Telephone
(SU06)

MAKE CHECKS PAYABLE TO USNCSA and mail to:
L. W. Sperberg, Jr., Secretary USNCSA
754 Point Arguello, Oceanside, CA 92058