NAME: ________________________________________________________________________________
                LAST                                                                         FIRST                                         M.I.
TIME ABOARD: ______________________________

SPOUSE?S or SIGNIFICANT OTHER
FIRST NAME and / OR NICKNAME:______________________________________________________

ADDRESS:_____________________________________________________________________________

CITY, STATE, ZIP: _____________________________________________________________________

Phone #: ______________________________ Email address: _________________________________

What do you do now? If retired what did you do? ___________________________________________

_______________________________________________________________________________________
Would you be interested in assisting us in future reunions as a volunteer or as an officer in the 
Association? _____________________

Do you have any suggestions or ideas for future reunions? _____________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Please enclose $10 for your 2003 dues. Make the check out to, send with this page, which you have printed and filled out, to:

USS Preble Reunion Association; 
c/o Eugene Wamsley; 969 ST RT 28 Lot 6
Milford, OHIO 45150
(513) 248-4026

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