Island X-3 Salem, OR

APPLICATION FOR MEMBERSHIP
NAVY SEABEE VETERANS OF AMERICA

JUST PRINT THIS PAGE ON YOUR PRINTER
FILL IT OUT AND MAIL IT IN
IT IS JUST THAT SIMPLE.

I HEREBY APPLY FOR MEMBERSHIP IN THE NAVY SEABEE VETERANS OF AMERICA

I SOLEMNLY PLEDGE MYSELF TO PROMOTE THE WELFARE OF ITS MEMBERS, AND TO PERPETUATE ALLEGIANCE TO AMERICA,

TO THE AMERICAN FLAG AND TO AMERICA’S FREE INSTITUTIONS.

MEMBERSHIP FOR: Island X-3 Salem,OR

Name__________________________________________________________________________________

Address:________________________________________________

City_____________________________________________________

State;_________________________ Zip ______________________

Phone_____________________________________

Date Of Birth__________________________

Unit(S) Served With:___________________________________________________________________

Discharge Date ________________________________
Type Of Discharge________________________________

Name of  Spouse _________________________________

E-Mail Address:______________________________________________

Signature___________________________________________Date:______________________________________

Annual dues are $15 per year, July1 -June30. Payable at time of application and each year thereafter on June 1.

Life Membership rates based on age with the cost being:

18 to age 40 -------$180.00

41 to age 69--------$155.00

70 and over---------$130.00

Make checks payable to:
Island X-3OR 

Mail To:  SEC"Y: GARY R. STRAUSBAUGH, 1777 Sonya Dr. SE, Salem, OR 97301-8913