MEMBERSHIP FORM, USMMA Parent Assoc. of IN/KY/TN2008-2009 Academic Year Midshipman’s Father:_______________________ ____________________________ (Last Name) (First Name) Father’s Address: ____________________________________________Phone:____________________________ _____________________________________________E-mail: ___________________________ Cell #: ___________________________ Midshipman’s Mother: _______________________ _________________________ (Last Name) (First Name) Mother‘s Address ____________________________________________ Phone: _________________________ (If not the same) ____________________________________________ E-mail: _________________________ Cell #: __________________________ Plebe/Midshipman/Alumnus ______________________ ____________________ Class Of: ________ (Last Name) (First Name) Birth Date: ________ Company: __________ Box Number: __________ Sea Split: _______ Graduate’s Mailing Address: ___________________________ Phone: ____________________________ ___________________________ E-mail: ____________________________ Please check any offices or committees that might interest you in the future: ____ President; ____ Treasurer; ____ Secretary; _____ Ways and Means; _____ Membership Recruitment/Retention; _____ Newsletter/Website Coordinator; _____ Gee Dunks; _____ Cards; _____ All Academy Ball Committee; ____ All Academy Dinner Chair; _____ Other Membership Fee Information Make checks payable to: USMMA Parent Assoc. of IN/KY/TN Midshipman/Family $30.00 Alumni $30.00 Please send checks and membership form to: Barbara Shephard, 3199 S 500 E, Marion, IN 46953 Do you have membership badges (if not, see next section)? ________ Membership Badge Information: Members of the parent club receive very nice, magnetic nametags to wear at our meetings or at Parents’ Weekend. Badges are ordered once per year. Please fill out the following information so that we can order your badges: Badge #1: Your Name, First and Last: _______________________________ Plebe or Midshipman’s First Name: _______________________________ Graduating Class Year: _______________________________ Badge #2: Your Spouse’s Name (if applicable) First and Last: ________________________________ Plebe or Midshipman’s First Name: ________________________________ Graduating Class Year: ________________________________
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USMMA Parents Club of Ind/Ky/Tn
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