| DATE:___________________________
NEW_______RENEWAL_______
NAME:___________________________________RANK/RATE__________
ADDRESS_________________________________DOB:______________
CITY__________________________STATE:_______ZIP+4_____________
SPOUSE:_________________PHONE NO.: ( ___
)____________________
DEPT/DIV.:___________DATE
ABOARD:____________TO_____________
EMAIL ADDRESS
_______________________________________
MEMBERSHIP DUES ONE YEAR (July 1 -
June 30) $25.00 _________
MEMBERSHIP DUES THREE
YEARS
$70.00 _________
USS GLACIER BASEBALL CAP:
(Includes Postage)
$15.00 Ea_________
USS GLACIER DEEPFREEZE
PATCH:
$6.00 Ea_________
USS
GLACIER OPERATION DEEPFREEZE (1") PIN: $5.00 Ea_________
(Similar to the blue DEEPFREEZE
patch with the penguin on
it)
USS GLACIER ASSOC.
WINDOW
DECALS
(inside): $3.00
Ea_________
USS GLACIER JACKET
$115.00 Ea_________
USS
GLACIER
PAINTING
$55.00 Ea_________
DONATIONS - OPTIONAL - (Postage, Supplies
etc.)
_______________
Total Amount Enclosed:
_______________
__________________________
Signature
|
|
Make
checks payable to:
USS GLACIER ASSN/Gordon Wagoner
and mail along with this application
to:
Mr. Gordon Wagoner
Association Treasurer
4120 Pepperwood Trail
Minnetonka, MN 55305
Need a little more information?
Phone: 1.952.935.1107
Email: gdwagon@comcast.net |
Printer
Friendly | | 
