APPLICATION FOR MEMBERSHIP      Regular     Life     Associate      
OUR CREED:     “To perpetuate the memory of our shipmates who gave their lives in the pursuit of their duties while serving their country. That their dedication, deeds and supreme sacrifice be a constant source of motivation toward greater accomplishments. Pledge loyalty and patriotism to the United States of America & its Constitution.”
        
With my signature below I affirm that I subscribe to the Creed of the United States Submarine Veterans, Inc., and agree to abide by the Constitution, all Bylaws, Regulations and Procedures governing the U.S. Submarine Veterans, Inc., so long as they do not conflict with my military or civil obligations.  I will furnish proof of my eligibility for Regular membership, including my discharge under honorable conditions, and proof of my U.S. Navy (SS) Designation, if required by the Base or the national Membership Chairman.  If I am not discharged, the discharge requirement is waived.  If I am not U.S. N. submarine qualified, I am applying as an Associate and my sponsor is indicated below.

□  I certify that I was designated qualified in USN Submarines aboard ______________________ in _________ (Yr)
(Honorary designations regardless of source do not apply under any circumstances.)
□  I certify that I received a discharge under Honorable Conditions (if not currently in military service) in _______ (Yr)

Name: (Print /Type)___________________________________ Address: ____________________________________ 

City: _________________________   State: ____ Zip Code: _______-______     Tel: (______) ______-__________

Signature: ____________________________________________________         Date:     ______/______/________

Your E-Mail Address ________________________________          Base/Chapter Desired: ___________________

The Member Dues year runs from Jan 1st thru Dec 31st.  Please indicate your term preference: ______________________
Nat’l Dues:  5 Yr term:  $ 90.00; 3 Yr term:  $ 55.00; 1 yr term (Jan thru Sep) $ 20.00; (Oct thru Dec adds the next yr): $ 25.00
Nat’l Life:  76+ yrs = $100.00; 66 thru 75 yrs = $200; 56 thru 65 yrs  = $ 300.00; 46 thru 55 = $400.00; Thru 45 yrs = $ 500.00
Local Base/chapter dues are separate and additional.  Consult the local base for those figures.

How did you find USSVI?  □  Friend,  □  Boat Assn, □  Local Event/News, □  Internet, □  Other (________________)

Who is your sponsoring USSVI Regular Member?: (Mandatory for Assoc  Mbrs) ____________________________
Associate Applicant is:   Veteran   Spouse of Veteran    Other (specify)    _______________________

Upon completion, please deliver to: Your Base Chapter Secretary, or if you do not know of a base location near you, 
Mail to: USSVI National Office, P.O. Box 3870, Silverdale, WA  98383-3870
Questions:  Call 1-877-542-DIVE or email office@ussvi.org                  

YOUR U.S. NAVY BIOGRAPHICAL DATA

Date Of Birth (MM/DD/YY) ____/____/____              If other military service, What Branch?  __________

Highest Rate & Rank Attained: _____________  Mil Retired (Y/N):  _____   On Active Duty? (Y/N): ____

YR entered Mil Service:  ______  YR left Mil Service _____  (Active/Inactive reserve time also counts.)

Submarines and ships served aboard as ship’s company (Use back if you need more space.)  

1.	 ___________________________              Hull#______________          From Yr.____   to Yr. _____ 

2.	 ___________________________              Hull#______________          From Yr._____ to Yr. _____ 

3.	 ___________________________              Hull#______________          From Yr.____   to Yr. _____ 

4.	 ___________________________              Hull#______________          From Yr._____ to Yr. _____ 

5.	 ___________________________              Hull#______________          From Yr.____   to Yr. _____ 

6.	 ___________________________              Hull#______________          From Yr._____ to Yr. _____ 

Next of Kin:    Name: ________________________________   Relationship:  ________  (Spouse, Partner, Son, Dau, Parent, Other)

Addr:________________________  City:  ___________________    State: ___    Zip: _________ Tel: _______________________
(Leave this address line blank if the same as your home address)
                 
Applicants on active duty are requested to provide a permanent home address.