LIFE MEMBERSHIP = $100.00
ANNUAL MEMBERSHIP = $10.00/YR
MEMBER INFORMATION:
Name: _________________________________________________
Address:________________________________________________
City:________________________________________ State:________
Zip:________+ 4 ___________ Phone: ( ______ ) _________
-______________
e-mail address __________________________
Spouse Name: ___________________(optional)
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Type of membership enrolling for: [Check one]
Regular: SSN571 _________ SS168_________ Widow:________
[Ships Company or
attached personnel serving for a period of 30 days or
more.]
Auxiliary: _________ [Persons interested in establishing
for NAUTILUS its permanent
place in history and assisting wherever possible in establishingand
maintaining the highest traditions
of the United States Navy.]
Served in Nautilus from: __________________________ to_________________________
Rate / Rank while on board.________ USN Retired?______
Ultimate Rate /Rank___________
Plank Owner?:___________ PANOPO [Transpolar crew member]?:
___________
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Make Checks payable to : NAUTILUS ALUMNI ASSN.,
INC.
Mail this form and check to:
NAAI ** The Life Membership dues are deposited in a
separate investment account which keeps earning in your name even after your demise; thereby continuing
to support the association.
c/o Richard Young
PO Box 623
Kuna ID 83634