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United States Submarine Veterans Inc.
APPLICATION FOR MEMBERSHIP
Regular Life Associate
OUR CREED:
“To perpetuate the memory of our shipmates who
gave their lives in the pursuit of their duties while serving their country.
That their dedication, deeds and supreme sacrifice be a constant source of
motivation toward greater accomplishments. Pledge loyalty and patriotism to
the United States
Government”
I subscribe to the Creed of the United States Submarine Veterans, Inc., and
agree to abide by the Constitution, all Bylaws, Regulations and Procedures
governing the U.S. Submarine Veterans, Inc., so long as they do not conflict
with my military or civil obligations. I will furnish further proof of my
eligibility for Regular or Life membership, including an Honorable Discharge
and U.S. Navy (SS) Designation, if required by proper authority.
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Date: ________/_______/_______
Name: (Print or Type) _________________________________________
Signature:___________________________________________________
Address:____________________________________________________
City:___________________________________
State:
_______________
Zip Code:___________ -_______
Tel:
(_____) _______________
E-Mail Address:______________________
Base Desired: _______________________________________________
Sponsor:____________________________________________________
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This box is for Associate applicants or for Groton
Base Membership Only
Associate Applicant is (Check one): Veteran
Spouse of Veteran
Other (specify) _______________________
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NATIONAL DUES:
Annual: 5 yr: $ 90.00 - 3 Yr: 55.00 - 1 Yr: $20.00
Life: (Age 76 + =
$100) (66 to 75 = $200) (56 to 65 = $300) (46 to 55 =
$ 400.00
(Thru 45 = $500)
Annual Base Dues: ($10, or as prescribed by Base)
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BIOGRAPHICAL DATA
(New Members/Updates/Changes)
Please provide the
information requested below. This information will be retained in the
National and/or Base Database Individual Bases may request additional data
for their specific use only.
Date Of Birth (MM/DD/YY) ____/____/____
Spouse _______________________________
Highest Rank Attained: __________________
Retired
(Y/N): _____ Active
Duty (Y/N): _____
Qual
Boat:______________________________________________Hull#_________
Qual Date (MM/YY) ____/_______
Next of Kin if other than Spouse:
Name: _______________________________
Relationship: (optional) ___________________
Address:__________________________
City: ___________________
State: ______
Zip: _________-________
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Other Boats Served In:
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_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
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Hull#
________
Hull#
________
Hull#
________
Hull#
________
Hull#
________
Hull#
________
Hull#
________
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From Yr_______
From Yr_______
From Yr_______
From Yr_______
From Yr_______
From Yr_______
From Yr_______
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to_________
to_________
to_________
to_________
to_________
to_________
to_________
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Upon completion, please
deliver to:
Your Base Secretary , or
if you do not know of a base location near you,
Mail to: USSVI National Office, P.O. Box 3870, Silverdale,
WA 98383-3870
Applicants serving on active duty are requested to
provide a permanent address through which they may be contacted. (Continue on
back if necessary)
USSVI Apform
Rev. 21 Sept. 2004
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