Print form and mail to appropriate address listed below

U.S.S. VIRGO Association
Registration, Dues and Information Update Form

PLEASE PRINT CLEARLY

Your Name                                                                                                    

Spouses First Name                                                                                       

Address                                                                                                        

City                                                                                                              

State               Zip Code                      Telephone                                           

Your Web site                                                                                               

Dates Served Vietnam                           Other Dates Served                          

Rate                           Rank                           Division