Navy Nuclear Weapons Association Membership Application/Renewal Application

 ________Enroll me as a member. $10.00 entry fee plus $10.00 annual membership fee ($20.00 total) and $10.00 annually.

 ________Enroll me as an Associate member. $15.00 entry fee plus $10.00 annual membership fee ($25.00 total) and $10.00

                 annually.  Need recommendation of NNWA member for eligibility

 ________Please reinstate my past due membership which expired in _____. $10.00 reinstatement fee plus $10.00 annually

________Please renew my membership - enclosed is my renewal dues at $10.00 for each year of renewal

APPLICATION INFORMATION (Items marked ** required for renewal)

**First Name  
Middle Name  
**Last Name  
Spouse Name  
**Street Address  
**City                                                                  **State/ZIP
**Phone Number                                                            Fax Number
**E-mail address  
Please list those US Navy organizations you have been attached to for the membership qualification requirements:  
 
 
 
 
Rank/Rate on Separation      
Years of service From                                                 to                   
Select one Discharged   c                   Retired    c 

We value your privacy.  We will publish your name on our website, but will only publish other information with your permission.  Please indicate the information you permit us to publish and sign this application prior to submission.

**You may publish:  My address: c  My phone number: c  My e-mail address   c

**Date_______________________   ** Signature: __________________________________

  c Check here if you wish to receive rosters, bulletins, etc. electronically (by e-mail)

Make checks payable to:  NNWA Treasurer

Send check and app to:

Frank Kelly

1087 Frank Kelly Rd

Society Hill, SC 29593