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 -- New Member & Renewals)
(NOTE: Returning members after an absence must renew as a New  Member)
Form Of Payment:                                                                       
(Account Not Required Use Credit Card-Close browser tab/session tab when finished)            
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