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Data Category
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Current Information
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Member Full Name #
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USNA Class or Affiliation
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Spouse #
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Home Address
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Home Address (Additional)
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Home City, State
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Home Zip
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Home Phone
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Employer
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Business Address
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Business Address
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Business City, State
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Business Zip
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Business Phone
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Email Address
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# These names will also be used for your name tags.
Please select one of the choices below:
Dues:
$25 ($10 for active duty personnel) for 12 months. $40
for 24 months. Please make checks payable to "USNA AA CT
Chapter."
Mail this form to:
Tom
Hogsten '85, 27 Bobwhite Trail, Gales Ferry, CT 06335.
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