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:


Richard Hartman

25 Greenleaves Dr. #510

Amherst, MA 01002-2852


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. ___________________________________________