Membership Form

*When you fill out this form, and submit the information you will be taken another page that should be printed out and mailed along with dues.

Name Info
Last Name:		First Name:	MI:
Nickname:		Spouse Name:	Spouse Nickname:
Address Info
Street:		City:	State:
Zip Code:
Contact Info
Home Phone:		Cell:	Primary Email Address:
Alt Email Address:		Your Website URL:
Service Info
U.S. Navy Retired?
Years served in VP4:		Second tour?	Second tour years:
What were your duties in VP4? (Rank/Crew/Dept/Org/etc.)
Additional Remarks/Comments
If you were recruited to join by a current member of the VP-4 Veterans Association, please provide the name of the member.
Sponsor:
Funding an association of this size, shipmates from the 1940s to the present is expensive. The VP-4 Veterans Association Committee is asking you to participate by sending in either your $20.00 2010-2011 Annual or $100.00 LIFETIME dues. These funds are used to help cover the costs of materials, mailing, and other association and reunion-related expenses.
Dues Enclosed:	$20.00 (Total for 2 years) 2010-2011
	$100.00 LIFETIME
2011 Reunion Attendance
	I DO PLAN to attend the 2011 Reunion.
	I DO NOT PLAN to attend the 2011 Reunion.
	Please make your check payable to VP4 Association #902-9463 and mail to: VP-4 Veterans Association c/o Larry Hames 21015 124th Ave E Graham, WA 98338-8847

VP-4 Association