APPLICATION FOR MEMBERSHIP

Return by Mail to: SEAWOLF ASSOCIATION C/O William R. Simpson 625 N. Neel St. Kennewick, WA 99336 wrseawolf5@msn.com Ph: 1-509-783-2031 Name:___________________________________________________________ Address:________________________________________________________ City:_________________________________State:_______Zip:_________ Phone:(_______) ___________________ E-MAIL: ____________________ ELIGIBILITY 1. Must have served with the SEAWOLVES, SEALORDS, or FASU BINH THUY to become a REGULAR or LIFETIME member 2. ASSOCIATE MEMBERS may be any person who was affiliated with the above listed organizations or who has and interest in the organization or what it stands for. 3. FAMILY MEMBERS of those Killed in Action or who have died since returning from Vietnam are eligible as long as they wish to be affiliated with the organization. MEMBERSHIP TYPE LIFETIME --$250.00 - Full Privileges (Life Membership may be paid with five consecutive quarterly payments of $50) REGULAR - Dues $25.00 per year, Full Privileges ASSOCIATE - Dues $25.00 per year, No Voting Privileges FAMILY - $10 per year, no voting privileges BACKGROUND INFORMATION Dates in-country__________________________Detachments(s:________________ Rank/Rate then:_________________________________________________________ Present Occupation:_____________________________________________________ Special Skills:_________________________________________________________ Willing to Help (Y/N)?_____If "Yes", how?_____________________ How did you hear of the Association?_____________________________________ Comments________________________________________________________________ "I certify that all of the above information is true to the best of my knowledge and belief; and that I am elegible in all respects for the membership type applied for." Signature______________________________Date:________________________ Approved:____________________________ Title:________________________________ Date:___________