MEMBERSHIP APPLICATION
USS LOS ANGELES CA-135 ASSOCIATION

NAME: __________________________________________________________

RANK/RATE: _____________________________________________________

DIVISION: _____________________________________________________

DATES ON USS LOS ANGELES:  from______________   to________________

WIFE'S NAME: ________________________________________________

CURRENT ADDRESS: __________________________________________________
                                  _______________________________________
                                  _______________________________________

PHONE NUMBER: _______________________________________________

EMAIL ADDRESS: _______________________________________________

ASSOCIATION DUES:   $25 ANNUALLY FOR ACTIVE MEMBERS (may attend reunions & other functions);  $10 FOR NEWSLETTER ONLY.

Print this application and send it to the address below along with your check for $25 (or $10):
 

USS Los Angeles CA-135 Association Membership Mr. Jim Osborne 1314 N. Alden Rd Muncie, IN   47304-2903