USS. Henrico APA-45 Submission Application

Mail to: Mr. Don Soper
             P.O. Box 1790
             Platte City, MO  64079-1790

I hearby submit my application to the USS. Henrico Reunion Association

Name: ______________________________________________________

 

Address: ____________________________________________________

 

City/Town: ___________________________________________________

 

State: ______________________________

 

Zip: ________________________________

Wife's Name:_________________________

Years served on board: ______ to _______

 

Division: ____________________________

 

my e-mail address: ______________________________________________

Web Site:   http://__________________________________________________

 

Enclosed is a check for $20.00 for my Life Membership in the Association......[YES]......[NO] Enclosed is a copy of my DD-214 and my 605 form showing my years on board. PLEASE PRINT THIS OUT and mail it to the address listed above and thank you!  Click on File and Print on your toolbar above to print this application to mail in.  Thank you.

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