USS Enterprise CVAN/CVN-65 Association Membership Form 
                                             Fields Indicated in RED are REQUIRED Fields
 Submission Type                  
  Membership Number (current members only)   


First      Initial       Last     Nickname  

 Spouse            

Street    City     

State      Country     Zip/Post  

Phone     Cell      

Email    
  
Enterprise OnBoard Information
Rank/Rate           Command         

Department         Division          
                                                                                                                         
Years On Board  
(Enter years with comma between  ex: 74,78,77-79,)                    
Recruited By :    

Membership Type:
           
Dues(Number of Years and Payment Method -- New Member & Renewals)                      
         
      
           
(NOTE: Returning members after an absence must renew as a New  Member)
Form Of Payment:                                                                       
                     
                                                        
   Print the form for your records then press submit