registration mail-in form

MAIL-IN REGISTRATION FORM

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then click on "PRINT" OR "PRINT THIS PAGE"

CLICK ON THE "BACK BUTTON" TO RETURN TO THE WEBSITE

PLEASE PRINT THIS FORM AND MAIL WITH YOUR CHECK OR MONEY ORDER

TO:

LOWELL POGATCHNIK

2164 Finland Ave

Finlayson MN 55735

PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO:

U.S.S. CARPENTER SHIPMATES ASSOCIATION

SHIPMATE OR WIFE NAME:

STREET ADDRESS:

CITY AND STATE:

ZIP CODE:

EMAIL ADDRESS:

PHONE NUMBER & AREA CODE:

FAX NUMBER & AREA CODE:

RANK OR RATE:

YEARS SERVED ABOARD:

PLEASE MAKE SEPARATE APPLICATION FOR SHIPMATE AND SPOUSE

MEMBERSHIP FEE PER SHIPMATE OR SPOUSE

$20.00 PER YEAR PER PERSON

DON'T FORGET TO MAIL YOUR CHECK TO ACTIVATE YOUR MEMBERSHIP!

SHIPMATE OR WIFE NAME:
STREET ADDRESS:
CITY AND STATE:
ZIP CODE:
EMAIL ADDRESS:
PHONE NUMBER & AREA CODE:
FAX NUMBER & AREA CODE:
RANK OR RATE:
YEARS SERVED ABOARD: