APPLICATION FOR MEMBERSHIP      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”
        
        NATIONAL DUES:

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.  I will furnish further proof of my eligibility for Regular or Life membership, including an Honorable Discharge and U.S. Navy (SS) Designation, if required by proper authority.

     ANNUAL:
          5 Yr: $90.00 - 3 Yr:  $55.00 - 1 Yr: $20.00
LIFE:
76+ yrs: $100.00;   66 to 75 yrs: $200.00;         56 to 65 yrs:  $300.00;   46 to 55 yrs: $400.00; To & thru 45 yrs:  $500.00

                      Annual Chapter (Base) Dues:
                ($10.00 or as prescribed by Base)

   Signature: _______________________________________________________________      Date: ____/____/______

Name: (Print or Type)_________________________________    Address: _____________________________________ 
                                                      
City: ___ _______________________ __   State: _____   Zip Code: ______ _-______    Tel: (______) ______-______

E-Mail Address (If applicable) _________________ __________________      Base Desired: ____________________

For Associate Members only:  Sponsoring USSVI Regular Mbr:_________________________________________ 
Associate Applicant is:   Veteran         Spouse of Veteran         Other (specify)    _______________________

Upon completion, please deliver to: USSVI Yakima Base Secretary
Mark Briggs, 1417 South 44th Avenue, Yakima, WA  98909                      

BIOGRAPHICAL DATA (New Members/Updates/Changes)

Please provide the information requested below. This information will be retained in the National and/or Base Database. Individual Bases may request additional data for their specific use only.

Date Of Birth (MM/DD/YY) ____/____/____                  Spouse _______________________________                                                

Highest MOS/Rate/Rank Attained: ________________        Mil Retired (Y/N):  _____      Active Duty (Y/N): ____

Qual Boat: ______________________ Hull#_________ Qual Date (MM/YY) __/__   From Yr._____to _____ 

Other Boats: ___________________________             Hull#______________          From Yr.____  to _____ 

                      ___________________________              Hull#______________          From Yr._____ to _____ 

                      ___________________________              Hull#______________          From Yr._____ to _____ 

                      ___________________________              Hull#______________          From Yr._____ to _____ 

                      ____________________________            Hull#_______________        From Yr._____ to _____ 

                      _____________________________          Hull#_______________        From Yr. _____ to _____

Spouse or other Next of Kin:    Name: ____________________________________   Relationship:  ___________________

Addr:________________________  City:  ___________________    State: ___    Zip: _________-________ Tel: __________________

                   Applicants serving on active duty are requested to provide a permanent address through which they may be contacted.
                                                                                      (Continue on back if necessary)