Registration Form

USS Magoffin Association

 

 

NAME:__________________________________________

 

ADDRESS:_______________________________________

 

CITY:_____________________STATE:_______ZIP:______

 

PHONE:  (_____)_______________ 

 

EMAIL:__________________________________________

 

SIGNIFICANT OTHER:_____________________________

 

DATES SERVED ABOARD THE MAGOFFIN: 

FROM__________ TO__________

 

RATING/RANK__________________DIVISION__________

 

 

 

I am a new member, my 2011 dues ($20) are enclosed [  ]

My 2012 dues ($20) are enclosed [  ]

My 2013 dues ($20) are enclosed [  }

My 2014 dues ($20) are enclosed [  ]

 

Please mail this form and your payment to:

 

USS Magoffin Association

Joe Beninato, Treasurer

61 Macy Street

Raynham, MA 02767

 

Please make payment by check or money order.  Always make payable to USS Magoffin Association.  NOTE: Use your browsers print command, this should print out the dues form.