MEMBERSHIP APPLICATION (Rev 4.10)

NAVAL CRYPTOLOGIC VETERANS ASSOCIATION

NEW ENGLAND CHAPTER - (NCVA-NE)

NAME:_______________________________________________________

ADDRESS:____________________________________________________

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PHONE NUMBER: _____________________________________________

Spouse’s Name: ________________________________________________

E-MAIL: ______________________________________________________

NAVSECGRU AFFILIATION (e.g. Skaggs Island, Ca 1967-1969)
[Please continue on back of application if necessary]

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CURRENT OCCUPATION/INTERESTS: _________________________

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NCVA (National Organization) MEMBER: YES________    NO ________

May we publish your personal information (listed here)
on the NVCA-NE Member Bio-Page? YES ___ NO ___

Please initial to grant permission: _____

When completed, mail form with $5.00 (1-year dues) to:

Art Gowie

PO Box 599

Bangor, ME 04402-0599

(Make checks payable to: NCVA-NE)

* Donations for administrative costs are encouraged *

Phone: (207) 974-7866

E-MAIL: macintoshman@myfairpoint.net