NAVAL ACADEMY ASSOCIATION OF NEW YORK
MEMBER APPLICATION & DATA FORM
PERSONAL AND PROFESSIONAL DATA
NAME______________________________
(Last) (First) (M.1)
BUSINESS TITLE____________________
(Dir., Pres., Billet, etc.)
SALUTATION________________________
(Mr., Mrs., CAPT, etc.)
ORGANIZATION_____________________________
(Organization/ship/etc.)
USNA CLASS_____________
BUSINESS ADDRESS______________________
HOME ADDRESS__________________________
(Street/PO Box)
_____________________________________
(City, State, Zip)
BUS. PHONE________________________________
(area code) (number)
HOME PHONE________________________
(area code) (number)
BUS. FAX___________________________
(area code) (number)
HOME FAX___________________________
(area code) (number)
BUS. EMAIL________________________________
(area code) (number)
PERS E-MAIL__________________________
PRESENT PROFESSION______________________
SPOUSE'S NAME_______________________
GRADUATE SCHOOL___________________
Graduation Year_______
Field of Study___________
TYPE OF MEMBERSIRP
(check one)
VOTING [ ] USNA alumni (grad & non-grad) from greater New York
metropolitan Tri-state area; voting members sustain the chapter through
annual donations of $25 and higher per program year.
ASSOCIATE [ ] All others with an interest in supporting the NAANY
and its purposes; associates help sustain the chapter at $25 or higher.
[ ] I would be interested in a dining membership at the
Williams Club.
(Any member sustaining the chapter at a level of $25 or higher per
program year receives all mailings, newsletters, and the annually
updated Directory.)
I
would like to serve or help as:SIGNATURE__________________________________
(your authorization to publish data)
Please make your checks payable to NAANY and return this form
to:
NAVAL ACADEMY ASSOCIATION OF NEW YORK,
24 West Railroad Ave #115 / Tenafly, NJ 07670
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