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:                                                                       
            
         
           
  PLEASE Print the form and mail it and check to the below address