Name:  
Address:
City, State, Zip:
Phone:
E-Mail:
Date Served:

Application Date:  New      Renewal
Amount Submitted:       
  2009 YR ($20.00)      2010 YR ($20.00)      2011 YR ($20.00)
Comments:




Please send me a copy of the Amended Constitution and Bylaws.

Signature:

Make check payable to:  USS Great Sitkin (AE-17) Association
Mail completed form and dues to: USS Great Sitkin (AE-17) Association
                                                         c/o Jim Dunno
                                                         272 Stone Hedge Row
                                                         Johnstown,  OH 43031