Please provide the following information for our membership records.
NAME: ___________________ _______________________ _________________
Last First, Middle Initial Spouse
City State Postal Code Country
Home Phone E-mail Address
FAX Home page
From:__________To:________ _______ _______ __________
Dates on Sampson Hull No. Division Rank/Rating
______ Please register me as a REGULAR Member with full voting rights and send me a copy of Association Roster, By-Laws, periodic newsletter and all Notice mailings. I enclose $10.00 Annual Dues.
______ Please register me and/or my Spouse as an ASSOCIATE Member and send me a copy of By-laws and all Notice mailings. I enclose $5.00 Annual Dues.
PLEASE return to: Dave Brandt, Secretary
1 Ridge Lake Drive
Along with check, payable to USS Sampson Assn. for Annual Dues or Additional Donations.