USS Surfbird Association
Membership Registration Form

Please complete all applicable information

Name:_______________________________________ Wife's Name:_______________________

Date of Birth:________________(mm/dd/yy)                  Surfbird Plank owner:  ___ Yes   ___No

Retired Military:  ___ Yes   ___ No    Rate/Rank at retirement:_____________

Nickname:________________   Highest Rank/Rate attained while serving on Surfbird:________

Billet(s) served in while serving on Surfbird:_____________________________(Officers only)

Years serving on Surfbird 19____ through 19____

Email Address:______________________________________________________

WEB Page URL:__________________________________________

Street Address 1:____________________________________________

Street Address 2:____________________________________________

City:______________________________State:________Zip:________

Please include $10.00 check or money order for annual dues made payable to:  USS Surfbird Assocation

(You may remit dues payment for multiple years if desired)

Mail to:  

Tom Dannatt
2801 W 25th St.
Greely, CO 80634