USNA PARENTS CLUB OF CENTRAL PA

2007-2008 MEMBERSHIP APPLICATION

•  Please complete this form and submit with membership fee if applicable, no later than July 31 st.

(See dues structure at bottom of form. Deadline for Plebe parents is September 15 th .)

•  Information is used for the Membership Directory and to projects benefiting the Midshipmen of current members.

•  The 2007-2008 Membership year commences June 1, 2007.

MEMBER

Last Name: _______________________ First Name(s): ____________________________________

Other Family Member Names: _________________________________________________________

Home Address: _________________________________ PA Congressional District: ______________

City, State: _____________________________________ Zip Code: __________________________

Home Phone: (____)________________

Cell Phone: (____)________________

e-mail Address: ____________________________________

CURRENT USNA MIDSHIPMAN

Last Name: _____________________ First: ___________________ M. I.: _____ Class of: ________

Company: _______ [Plebe parents only -- please state Company by letter & number (Ex. A1, A2, B3, B4, C5, ...)

Alpha Code: ______________ P. O. Box: ____________________

Birthday: _______________________ e-mail Address: _____________________________________

Blue and Gold Officer: _______________________________________________________________

ALUMNUS(A)

Last Name: ________________ First: ______________ M. I.: ________________________________

Class of: ______ Branch of Service: _____________ Military Rank: ____________________________

Current Assignment: _______________________ e-mail Address: _____________________________

Mailing Address: ___________________________________________________________________

What would you like to learn most about the USNA? ________________________________________

_________________________________________________________________________________

Suggestions for programs, club activities, or meeting locations: __________________________________

_________________________________________________________________________________

Comments / Questions: _______________________________________________________________

_________________________________________________________________________________

Annual membership for:

Parents of Midshipmen currently attending Academy        $30.00

Parents of USNA Alumni or Alumni                                $15.00

Blue and Gold Officers                                                    gratis

Legislative members/staff                                                 gratis

Please send membership information and a check, if applicable (payable to USNA Parents Club of Central PA) to:

                Diane & Joe Innerst

                377 Benyou Ln

                New Cumberland , PA   17070-3075

•  If you provide your email address, the Club newsletter will be sent via e-mail attachment.  

Also, all notices and breaking news will be sent to your e-mail address.

•  Members without an e-mail address will continue receiving a hard copy of the Club newsletter via the US mail.