Blueback Base Membership Application

Complete this form to join USSVI and Blueback Base.
Membership dues is $35.00 a year ($20 for National and $15 to Blueback Base).
There is a one time initiation fee of $6.00 making the amount due with this form $41.00.
LIFE Membership in either / or both National and Blueback Base is available.
The cost is age dependent, so I will give you the prices by return E-Mail.

Membership is *
Name *
Address *
City *
State *
Zip *
Home Phone *
E-Mail Address *
Date of Birth *
Spouse *
Boat Qualified On *
Date Qualified *
Last Rate / Rank *
Currently Active Duty *
USN Retired *
Transfer from Another Base *
Which One
Other Boats Served On

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Last

Sunday 14 March 2010.
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BLUEBACK BASE - Portland, OR