ON-LINE MEMBERSHIP UPDATE FORM

This form will provide input to the association membership database. If that is not your desire, please click the BACK button on your browser now.

Instructions: You may make partial updates, such as updating only your email address. You are required to enter only First and Last name, and your primary e-mail address. Information provided in this form will be used for the sole purpose of Association Functions and will not be released to any other organization or activity.

Notice: Approval for use of this information in the Association Newsletter and on the Association Web Site is assumed unless you request otherwise in the Special Instructions area below, or via e-mail to the Association Director.

Warning: As a precaution against malicious use, this form automatically collects Internet Protocol information about the system from which it was posted.


Title(Mr/Ms/Mrs/Rank)

First Name

Middle Initial

Last Name


Status (select one)
ex-USN USN USN(RET) ex-USNR USNR USNR(RET)
ex-USA USA USA(RET) ex-USMC USMC USMC(RET)
ex-CF CF CF(RET) ex-RN RN RN(RET)
GS(RET) WECo BTL LMSC
Other (specify)


Address - Line 1

Address - Line 2

Address - Line 3


City (blank for APO/FPO)


State or Province Abbrv. (blank for APO/FPO)


Country or APO/FPO


ZIP or Postal Code


Home Phone Number [e.g.(nnn)nnn-nnnn]

Business Phone Number [e.g.(nnn)nnn-nnnn]


Primary E-mail Address

Alternate E-mail Address


Special Instructions/Comments