USS FULTON AS-11 ASSOCIATION

Membership Application

Membership dues are as follows;

Annual $10 per year, Lifetime $150 under age 60, $125 over age 60.

Make your check payable to USS Fulton AS-11 Association.

Please use your print button to print this page, fill it out, and mail it with your check to:

Emil Geffert

8907 Greiner Dr.

Houston, TX 77080-3006

Name: _______________________________________________

Address: _____________________________________________

City, State, Zip: _________________________________________

Phone Number: _________________________________________

Spouse’s Name: _________________________________________

Birthdates: _____________________________________________

Anniversary: ____________________________________________

VERY IMPORTANT, we need this information for our tax exempt status

Dates of Service in US Navy: ______________________________

Dates of service aboard USS Fulton: _________________________

Rank or Rate: ___________________________________________

Div. or Dept. ____________________________________________

Do you have any special memories or are you looking for a shipmate?

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