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