USS CANBERRA CA 70 - CAG 2

Members of the Crew Reunion Association

Membership Application

Personal Information:

First name:

Middle name, Initial:

Last name:

Nickname:

Street address:

City:

State/Province:

Zip/Postal Code:

Country:

Phone:

Fax:

Email Address:

Crew:

Please enter CA 70 or CAG 2

Division Assigned To:

Date you came aboard:

Please enter Month/Day/Year

Date you left Canberra:

Please enter Month/Day/Year

Rate/Rank Aboard:

Rate/Rank Off:

US Military Retired:

Please enter Yes or No

Rate/Rank at Retirement:

Wife's First Name: