MEMBERSHIP APPLICATION (Rev 1.3)

NAVAL CRYPTOLOGIC VETERANS ASSOCIATION -

NEW ENGLAND (NCVA -NE) CHAPTER

NAME:_______________________________________________________

MAILING ADDRESS:__________________________________________

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PHONE NUMBER: ____________________________________________

Spouse’s First Name: ___________________________________________

E-MAIL ADDRESS: (If any) _____________________________________

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ELIGIBILITY: (NAVAL SECURITY GROUP AFFILIATION)

(e.g. Former CT at Skaggs Island, Ca 1967-1969)

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CURRENT OCCUPATION/INTERESTS: _________________________

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CURRENT NCVA (National Organization) MEMBER:

YES__________ NO __________

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

(Donations for administrative costs are encouraged)

Make checks payable to: NCVA-NE)

Art Gowie

PO Box 322

Brooks, ME 04921

Phone: (207) 722-3615 e-mail: papabear@pivot.net