USS PROVIDENCE ASSOCIATION
Membership Form

Name

Mailing Address

City - State

Telephone #

Email address

Years aboard

 

Rate/Rank


Division
CL82 or CLG6
Yearly Dues ($20) $
Additional Contribution for
Display Case
$
TOTAL $



Make your check out to:

"Providence Association"
c/o Bill McCubbin
3444 Senour Road
Independence, KY 41051
Thank you in advance for your support.

Print out this form, fill it out and send it to above address.

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