United States Submarine Veterans Inc.
APPLICATION FOR MEMBERSHIP
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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 Government”

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 further proof of my eligibility for Regular or Life membership, including an Honorable Discharge and U.S. Navy (SS) Designation, if required by proper authority.
 
Date: (MM/DD/YY)
Name:
 
Signature:                                                                                                                                                                                      
 
Address:
City:
State:
Zip Code:
Tel (Include area code):
E-Mail Address:
Base Desired:
Sponsor:
 
This box is for Associate applicants or for Great Lakes Base Membership Only

Associate Applicant is (Check one): 

Veteran
Spouse of Veteran
Other (specify) 
Note: If additional room is needed attach a separate sheet.
    NATIONAL DUES:
    2009 rates: 1 year $20.00, 3 years $55.00, 5 years $90.00.
    Life: 45 and younger $500.00, 46–55 $400.00, 56–65 $300.00, 66–75 $200.00, 76 and older $100.00
     
    GREAT LAKES BASE DUES:
    2009 rates: $10.00 a year.   Life: $250.00 45 and younger, 46-55 $200, 56-65 $100, 66 and older $50.00.
BIOGRAPHICAL DATA
(New Members & Updates/Changes for Current Members)
    Please provide the information requested below. This information will be retained in the National and/or Base Database.
Date Of Birth (MM/DD/YY)
Spouse
Highest Rank Attained:
Retired (Y/N)
Active Duty (Y/N)
Qual Boat - Include Hull Number
Qual Date (MM/YY)
Next of Kin if other than Spouse:
Name
Relationship: (optional)
Address
City
State
Zip:

Other Boats Served In:
Type in date as Month/Year   Example: June 1970 - Type as 06/70
Name & Hull Number
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To
Name & Hull Number
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To
Name & Hull Number
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To
Name & Hull Number
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To
Name & Hull Number
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Name & Hull Number
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To
Name & Hull Number
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To
Upon completion for GREAT LAKES BASE, please mail the completed application to:
USSVI Great Lakes Base Commander, Scott Jaklin, 8516 21st Ave, Kenosha, WI  53143-6492. 
 
Upon completion for a USSVI National (Member at Large) membership please mail to:
USSVI National Office, P.O. Box 3870, Silverdale, WA  98383-3870
Applicants serving on active duty are requested to provide a permanent address through which they may be contacted. (Continue on back if necessary)
     
Great Lakes Base 2007 Application Form.  Revised 9/2/2006 by SLJ