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  


Street    City     

State      Country     Zip/Post  

Phone     Cell      

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 -- for New Members and Renewals)                      
Form Of Payment:                                                                       
   Print the form for your records then press submit