PLEASE PRINTOUT THIS FORM
USS WISCONSIN MEMBERSHIP AND OR CHANGE OF INFORMATION
Type of Membership:
Former Crew Member:__ Associate Member:__ Change of Information:__
City:________________________ State:_________Zip Code:_____________
Division: _______________ Rate/Rank while aboard:________________
Aboard from (Yr):______________ To (Yr):_______________
Plank Owner: Yes: _____ No: _____
Are you currently on active duty?: Yes:___ No: ___
If applying for Associate Membership please list the name of the Crewmember you are related to:
Division: _____________ Year(s) on board:____________________________
May we post your email address on line in addition to your other information?
Yes: _____ post my email address NO: _____ don’t post my email address
(Only Name, Division and Years on board will be posted)
Use space below to add additional family members in your household that want to become members. Please list full names and relationship.
Cost is $10.00 for each additional member.
Annual Dues are as follows: $20.00 for an individual and $10.00 each additional member of the same household.
Each member will receive a membership card and pin. Only one Badger will be mailed to the address of record.
Add additional family members here:
Please print and mail this application, along with your check to the address listed below.
Please make check payable to USS WISCONSIN ASSOCIATION
USS WISCONSIN ASSOCIATION
1956 S. Coolwell Rd.
Madison Heights, VA 24572
Upon receipt, you will receive your membership card, pin and a copy of our Association’s by-laws.
Membership questions can be sent to: Paul Zentmyer