LIFE
MEMBERSHIP APPLICATION |
USS SAMPSON ASSOCIATION |
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Personal
Information |
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Date:___________ |
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(Last Name) |
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(First Name, MI) |
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(Spouse Name) |
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(Address) |
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(City) |
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(ST) |
(ZIP +4) |
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(Home Phone) |
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(Work Phone - Optional) |
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(Mobile Phone) |
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(E-Mail Address) |
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(Web Site) |
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(Birth Date) |
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Division |
Rank/Rate |
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Mo and Yr |
Plank Ownner |
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Service |
Retired |
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Age |
Highest Rank |
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LIFE Membership is based on your age and is: |
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AGE GROUP |
FEE |
40 to 44 |
$210 |
60 to 64 |
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$120 |
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29 and Younger |
$295 |
45 to 49 |
$180 |
65 to 69 |
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$105 |
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30 to 34 |
$265 |
50 to 54 |
$160 |
70 to 74 |
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$80 |
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35 to 39 |
$235 |
55 to 59 |
$140 |
75 and older |
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$50 |
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NOTE: 1. You may pay the
full life membership fee in one payment or in ten equal monthly installments.
If you prefer to pay monthly, you should send an initial installment
of one tenth of the total fee for your age group with this application.
We will enter your life membership and send you your membership card.
You will be expected to forward balance of monthly payments. in a
timely manner. Your certificate will be forwarded upon receipt of final payment.
In the event a member paying on the installment plan finds that he
can not continue to make monthly payments, all monies previously paid will
be credited to paid up annual dues, currently $10.00. |
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NOTE
2. Any dues currently paid in advance
may be applied to reduce the fee for
your age grroup |
NOTE 3. Please return to
Dave Brandt, Secretary, USS SAMPSON ASSOCIATION, 1 Ridge Lake Drive,
Manning SC 29102-9512 |
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