membershipapplicationcc

If you would like to become a member and pay using your credit card,
please complete the following membership form.

IF YOU DO NOT WANT TO PAY BY CREDIT CARD PLEASE. CLICK HERE.

MEMBERSHIP/DONATION FORM
First Name:	Middle Initial:	Last Name:

Nickname:	Class Year:	Primary E-Mail Address:

Alternate Email:		Member Number (if known):

Phone Number:	Rank:	Service:	Status:

Spouse's Name:
Please check any and all that apply This is a membership renewal. I am a surviving spouse of the listed member. I am a member of the USNA Blue and Gold Team I do NOT want to be listed in the directory. I am the parent of a current midshipman. This is a new membership information request.

NAMETAG ( New applications or replacements only)
I would like a name badge with my donation of $35 or more.

If yes, please type your name below EXACTLY as you would like it to appear on the badge.

MAILING ADDRESS
Street (Line 1):	Street (Line 2):	Apartment/Suite/Unit:

City:	State: Zip Code:	Home Phone:

Check here if you would like to have someone call you.

Members are requested to make an annual minimum donation of $30 in lieu of paying GWC dues. This money is used to help defray the costs of the Chapter's Academy Awareness Program, targeting area young men and
women and providing them information and encouragement to apply for admission to USNA.
Your generosity is appreciated.

TOTAL DONATION: $

(If no monetary donation, please enter "none" in this field.)

Once you click the submit button you will be directed to
PayPals payment page.