Application - Navy Nuclear Weapons Association

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Application - Navy Nuclear Weapons Association
Navy Nuclear Weapons Association Membership/Renewal
Application
☐
Enroll me as a member. $10.00 Entry Fee Plus $10.00 annual membership Dues. ($20.00 Total)
☐
Enroll me as an Associate member. $15.00 Entry Fee Plus $10.00 Annual membership
dues ($25.00 Total) Needs Recommendation of a member in good standing for Eligibility
☐
Reinstatement of Past Member will be $10.00 Reinstatement Fee plus $10.00 annual
membership dues ($20.00 Total)
☐
Please renew my membership - enclosed is my renewal dues at $10.00 for each year of renewal
Note: Members may pay their annual dues in advance at $10.00 per year for as many years as
they wish. This will save members postage and the board a considerable amount of time in
processing payments
APPLICATION INFORMATION (Items marked ** required for renewal)
**First Name
Middle
Last Name
Spouse Name
**Street Address
**City
**State/ZIP
**Phone Number
**E-mail address
Please list those US Navy organizations you have been
attached to for the membership qualification
requirements and the dates you were at those
organizations: (you can use the back of the form for
additional entries)
** Date of entry into Navy's nuclear weapons program
**Rank/Rate on Separation _______________
**Select one:
☐ Discharged
☐
Yr/Mo _________ (e.g., 1960/05)
**Years of service: from _________ to __________
Retired
We value your privacy. We will publish your name and month of dues expiration on our
website, but will only publish other information with your permission. Please indicate the
information you permit us to publish and sign this application prior to submission. **You
may publish: ☐ My address: ☐ My phone number: ☐ My e-mail address
**Date_______________________ ** Signature: __________________________________
☐Check here if you wish to receive rosters, bulletins, etc. electronically (by e-mail) to save paper,
postage and time enroute to you)
Send check payable to NNWA Treasurer
and mail with app to:
Frank Kelly
1087 Frank Kelly Rd
Society Hill, SC 29593

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