It is requested that this form be completed to help keep the membership roster up to
                  date and as accurate as possible. Please make checks payable to USS NAVARRO
                  ASSOCIATION and return this form with your dues to:

                  Vernon Jackson
                  6509 54th Ave. NW,
                  Gig Harbor, WA 98335.
                  (253) 851-5195
                  vernonjackson@att.net

                  NAME:_________________________________________________________________

                  SPOUSE:_______________________________________________________________

                  ADDRESS:______________________________________________________________

                  CITY,STATE,ZIP CODE:_________________________________________________

                  HOME TELEPHONE NUMBER:___________________________________________

                  CELL TELEPHONE NUMBER:____________________________________________

                  EMAIL ADDRESS:_______________________________________________________

                  HIGHEST RANK/RATE HELD ONBOARD USS NAVARRO:__________________

                  DATES OF SERVICE ONBOARD USS NAVARRO:__________________________

                  RETIRED USN RANK/RATE:_____________________________________________

                  RETIRED USNR RANK/RATE:____________________________________________

                  DUES FOR ONE YEAR $15.00:__________________________

                  DUES FOR FIVE YEARS $70.00:_________________________