Application for Membership in the

(www.usshissem.org)

U.S.S. Hissem DE/DER-400 Association

Please print, fill out and mail with check/m.o. for $10.00 U.S. dollars to:

USS HISSEM DE/DER-400 ASSOCIATION

Membership Application:

NAME_________________________RATE/RANK_________YEARS ABRD____________

ADDRESS____________________________________

CITY___________________STATE______ ZIP_______

WIFE’S FIRST NAME_____________________PHONE_____ _____ __________

EMAIL ADDRESS: __________________________________________

Call Sign if Amateur Radio Operator: _________

See U.S.S. Hissem Amateur Radio Web Site at: www.nhvn.org

WELCOME ABOARD