Association Membership Form

USS NAVARRO (APA-215)
REUNION ASSOCIATION
ANNUAL DUES FORM

It is requested that this form be completed to help keep the membership roster up to
date and as accurate as possible. Please make checks payable to USS NAVARRO
ASSOCIATION and return this form with your dues to:
Vernon Jackson
6509 54th Ave. NW,
Gig Harbor, WA 98335.
vernonjackson@att.net
(253) 851-5195
NAME:_________________________________________________________________

SPOUSE:_______________________________________________________________

ADDRESS:______________________________________________________________

CITY,STATE,ZIP CODE:_________________________________________________

HOME TELEPHONE NUMBER:___________________________________________

CELL TELEPHONE NUMBER:____________________________________________

EMAIL ADDRESS:_______________________________________________________

HIGHEST RANK/RATE HELD ONBOARD USS NAVARRO:__________________

DATES OF SERVICE ONBOARD USS NAVARRO:__________________________

RETIRED USN RANK/RATE:_____________________________________________

RETIRED USNR RANK/RATE:____________________________________________

DUES FOR ONE YEAR $15.00:__________________________

DUES FOR FIVE YEARS $70.00:_________________________

DUES FOR PAID UP LIFE MEMBERSHIP $130.00:_________