APPLICATION FOR 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 _____/______

Make your check or money order for $20.00 payable to:

USS Will Rogers Veterans Association, Inc.

And mail your check along with this form to:

USS Will Rogers Veterans Association, Inc.

c/o Ed Greany, Vice-president

PO Box 720790

Pinon Hills, CA 92372-0790