Regular Life Associate
OUR CREED:
“To perpetuate the memory of our shipmates who gave
their lives in the pursuit of their duties while serving their country.
That their dedication, deeds and supreme sacrifice be a constant source
of motivation toward greater accomplishments. Pledge loyalty and patriotism
to the United States Government”
I subscribe to the Creed of the United States Submarine Veterans, Inc., and agree to abide by the Constitution, all Bylaws, Regulations and Procedures governing the U.S. Submarine Veterans, Inc., so long as they do not conflict with my military or civil obligations. Upon request, I'll furnish further proof of my eligibility for Regular or Life membership, including an Honorable Discharge and U.S. Navy (SS) Designation.
Name: (Print or Type) ____________________________ Signature:_______________________________________
Address:____________________________________________________
City:___________________________________ State: _______________
Zip Code:_________ -_______ Tel: (_____) _______________ Cell #(_____) ____________________
E-Mail Address:________________________ Sponsor:____________________________________________
Base Desired if other than Perch Base _____________________________ Date: ________/_______/_______
NATIONAL NON LIFE DUES:
Five Year: $90.00 - Three Year $55.00 - One Year: $20.00
LifeDues: (Under 45 = $500.00)
(46 to 55 = $400.00) (56
to 65 = $300.00) (Age 66 to 75
= $200.00) (76 & over $100.00)
PERCH BASE DUES
Annual Perch Base Dues: ($10.00)
Perch Base Life Membership: (Under 45 = $250.00) ( 45 to 55 = $150.00)
( 56 to 65 = $100.00) (66 and up $50.00)
BIOGRAPHICAL DATA
Please provide all information requested below. This information will
be retained in the National and Base Database.
Date Of Birth (MM/DD/YY) ____/____/____ Spouse
_______________________________
Highest Rank/Rating Attained: __________________ Retired (Y/N): _____ Active Duty (Y/N): _____
Qual. Boat:___________________________ Hull#_________
Qual. Date (MM/YY) ____/_______
Other Boats Served On: (Use Back Side if required)
________________________________ Hull# ________ From Yr_______ to ________
________________________________ Hull#
________ From Yr_______ to ________
________________________________ Hull# ________
From Yr_______ to ________
Next of Kin if other than Spouse:
Name: _______________________________ Relationship: (optional) ___________________
Address:__________________________City: ___________________
State: ____ Zip: _________-________
Upon completion, please mail to:
Ramon Samson - Membership Chair -
13210 N. Lakeforest Dr. - Sun City, AZ
85351-3252 - Tele 623-815-9247