MEMBERSHIP APPLICATION             

                              HELP US TO RECRUIT NEW MEMBERS!

For a two-year membership, mail a $20.00 check payable to USS HANCOCK Association

Send regular new memberships to:                               Send renewals or Life Memberships to:

Wayne Erven, Membership Chairman                          Don Yeggy, Treasurer

7173 Valley Trails Dr.,                                                  1129 Tulip Ave

Pleasanton CA 94588-5225                                          Riverside, IA 52327

Name: ____________________________________________Date of Birth__________________

(If you are retired military, we would like to include your rate or rank, and branch of service with

your name when we address you, or list you in our roster.)

Street Address: ________________________________________________________________

City, State, Zip  ________________________________________________________________

Wife’s Name___________________________Telephone_______________________________

Division or Squadron, and highest Rank/Rate on board  _________________________________

What years aboard (for example: l968 – 71) __________________________________________

E-Mail Address:  _______________________________________________________________

Life Memberships  Date of Birth________________Membership paid to________________

                                                                                            (check your newsletter mailing label)

Life Memberships are available as follows:

55 & below         $250.00        71-77               $100.00

56-60                  $200.00        78-84                 $75.00

61-65                  $150.00        85 & above        $50.00

66-70                  $125.00

Paid up members, deduct:

2012   $10.00

2013   $20.00

2014   $30.00

2015   $40.00

2016   $50.00

(Rev 1/11)