USS Enterprise CVAN/CVN-65 Association Membership Form 
                                             Fields Indicated in RED are REQUIRED Fields

 Submission Type   New Member    Renewal   Update Information   
  Membership Number (current members only)   
First      Initial       Last     Nickname  

 Spouse     
       
Street    City     

State    Select One Non-USA Alaska Alabama Arkansas Arizona California Connecticut Colorado Wash.DC Delaware Florida Gerogia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska Nebraska New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming   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 :    
Check to allow your Name, Div, Years to be displayed online.
Membership Type:
    Full Member(served aboard)        Associate Member(did not serve on Enterprise)
Dues(Number of Years and Payment Method -- New Member & Renewals)
One Year ($20)              2Year ($40)        
5 Year $80( 4 YRS get one free)        10 Year $160 (8 YRS get 2 free)
           
(NOTE: Returning members after an absence must renew as a New  Member)
Form Of Payment:                                                                       
  Press 'GoToPayPal' or Submit                                  
 Make Checks Payable To: USS ENTERPRISE Membership Mail Check and printed form to: Jerry Pearson, Treasurer PO Box 727 Fulton, MO 65251-0727