USS Will Rogers Veterans Association, Inc.                            

      c/o Ed Greany, Vice-president

PO Box 720790

Pinon Hills, CA 92372-0790

APPLICATION FOR

LIFE MEMBERSHIP

In the

USS WILL ROGERS VETERANS ASSOCIATION, INC.

(Please print)

Your name (first, middle initial, last) _________________________________________

Spouse (optional)(first, middle initial, last) ____________________________________

Address ______________________________________________________________

City _________________________________ State _____ Zip code ______________

Phone (____) ______________ Secondary or Cell phone (____) ________________

E-mail ___________________________ Secondary E-mail _____________________

Nick name(s) on the boat ________________________________________________

Rank/Rate when you left the boat _________________________________________

Positions or job on the boat  _____________________________________________

Number of Patrols on the Will Rogers _____________________________________

Crew (Blue and/or Gold and/or Decomm) __________________________________

From  Month/Year _____/______  to  Month/Year _____/____  Year of Birth 19 ____  

Your age:      Your Life Membership Fee:

  Under 45                N/A

  45-49                    $250               Please make your check or money order payable to:

  50-54                    $200               USS Will Rogers Veterans Association, Inc.

  55-59                    $150              

  60-64                    $100               and mail check / money order with your application to:

  65+                       $  50               USS Will Rogers Veterans Association, Inc.

                                                       c/o Ken Keelger, Treasurer

                                                        60 Mayflower Drive

                                                        Seekonk, MA 02771