Name:  

Address:

City, State, Zip:

Phone:

E-Mail:

Date Served on board:

Application Date:  New      Renewal

Amount Submitted:       
  2012 YR ($20.00)      2013 YR ($20.00)      2042 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