HAPPY VALLEY REUNION CLUB

MEMBERSHIP / RENEWAL APPLICATION
USS VALLEY FORGE CV45, CVA45, CVS45, LPH8, CG50

NAME: ____________________________________________________________________________

(LAST)                            (FIRST)                            (MIDDLE INITIAL)

SPOUSE'S NAME: ___________________________________________________________________

(LAST)                            (FIRST)                            (MIDDLE INITIAL)

ADDRESS: _________________________________________________________________________

(STREET ADDRESS)                            (OR)                            (P.O. BOX No.)

                      _________________________________________________________________________

(CITY OR TOWN)                            (STATE)                            (ZIP CODE)

HOME PHONE: _____________________________________________________________________

(AREA CODE)--(SEVEN DIGIT NO.)

BUSINESS PHONE: __________________________________________________________________

(AREA CODE)--(SEVEN DIGIT NO.) + (EXTENSION)

E-MAIL ADDRESS: __________________________________________________________________

(INTERNET ADDRESS)@(ADDRESSEE'S DOMAIN)

SERVICE INFORMATION:

RATE / RANK: _________________________________ DIVISION: ___________________________

WATCH or WORK STATION: __________________________________________________________

YEARS SERVED ABOARD: ____________________________________________________________

                           (19XX) TO (20XX)

SIGNATURE: _____________________________DATE: ________________________

MEMBERSHIP DUES: $45.00 FOR 6 YEARS

MAKE CHECKS PAYABLE TO: HVRC

PLEASE MAIL TO:

MR. EDWARD THOMAS

HVRC Secretary/Treasurer

2901 WOODSLOPE DRIVE

RALEIGH, NC 27610

PLEASE USE BACK OF PAGE FOR REFERRALS, CONTACTS, COMMENTS AND SUGGESTIONS.

Rev.3 1/10/14