First and Last Name:
__________________________________________________________
Address:_____________________________________________________________________
City: ______________________________ State: ______ Zip: __________________
Telephone:
( _____ ) ______ - __________ Highest Navy Rank or Rate:_____________
List up to four ships you served on and the years aboard each:
USS
_______________________________ Hull #: __________
From: _____ to
_____
USS
_______________________________ Hull #: __________
From: _____ to
_____
USS
_______________________________ Hull #: __________
From: _____ to
_____
USS
_______________________________ Hull #: __________
From: _____ to
_____
Membership Contribution:
___ $25 ___ $30 ___ $50 ___ $100
____ Currently on Active Duty ($10)
Lifetime Membership:
Call us at (800) 223-5535
for information
|
Please Select Payment
Type: ___
Check ___ Money Order ___ Credit Card
If paying by credit card, please provide the following information:
Circle one: MC Disc Visa Signature: ________________________________
Card Number: _______ - _______ - ______ - _______
Exp Date: ____ / ____
|
Recruited by:
____________________________________________________________
Address:
________________________________________________________________
Questions? Call us at 1-800-223-5535 or contact us via e-mail at:
tcs@destroyers.org |
