Your first name
Last name
Suffix (Jr., III, USN Ret, etc.)
Street Address
Address 2
City
State
Zip
Your birthday (month/day)
Spouse's first name
Spouse's birthday (month/day)

• Please tell us something interesting about yourself that we might insert in our monthly newsletter. This could be about your present work, hobbies/interests and/or your connection to the sea services.

• How did you learn about the Navy League?

Someone asked me.    Know someone involved. Newspaper/other media.

Former service member who had contact with the Navy League.   

Received information in the mail.    Website. 

• Would you be wiling to serve as an officer? YES NO

  If yes, which position(s)? 

• Listed below are activities we support throughout the year. As a member of our council,  we need you to select the area or areas in which you have the most interest. We need your input to continue to offer more interesting and worthwhile events and activities for our members and community. If your schedule does not allow full participation at this time list your interests for future involvement. Our Council needs your active participation!
  

  Programs	Membership and Retention
  Education	Sea Cadets
  Ship Visits	Newsletter
  Web Site	Ship Visits
  Photography	Active Duty Liaison, USCG
  Activity Duty Liaison, USMC	Merchant Marine Liaison
  Sea Services Recognition	Community Affiliate Liaison
  Recruiting and Reserve Liaison, USMC

• Please provide the following contact information:

  Work Phone
  Home Phone
  FAX
  E-mail

• Which types of social activities do you most enjoy (golf, tennis, cruises, dances, other)?

• Do you have ideas for new or different programs which will help us better educate the community about the need for a strong maritime defense or to offer improved support of our men and women of the sea services? (Please describe below.)