USS FULTON AS-11 ASSOCIATION

Membership Application

 

Membership dues are as follows

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

Make your check payable to USS Fulton AS-11 Association

Please complete the following application and mail with your check to:

 

Dennis French

76 Sloop Dr.

Portsmouth, RI 02871-2925

  

Name: ________________________________________

 

Address: _______________________________________

 

City, State, Zip: ____________________________

 

Phone Number: _________________________________________

 

E-Mail Address: ___________________________

 

Spouse’s Name: _________________________________________

 

Birthdates: (yours):______________________Spouse:_______________________

 

Anniversary: (mm/dd/yyyy)____________________________________________

 

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. ___________________________________________