MEMBERSHIP APPLICATION PAGE
(Keep the  Association informed of any address changes)

Name:_______________________   _____________________  _____________________
                            (Last)                                                    ( First)                                                   (Middle)                          
Spouse's Name: ______________________________________

Street________________________________Apt._________City____________________________

State__________________Zip____________________Date of Birth__________________________

Home Phone: ( ____ )_____________________    Business / Work:( ____ )_____________________
Email Address:  ______________________________________     Add to Web Page? Yes Check Box    No Check Box
Also, Please Send Email Address For Web Page To:  littlerocksol@verizon.net

Please Note: There are five (5) categories for membership and you must select the one that accurately reflects
your status to be accepted into the USS Little Rock Association.  Please check only one category. 

All applications are subject to approval from the Board of Directors of the USS Little Rock Association. Only mem-
bers of Classes A and B are eligible to serve as Officers or Directors of the Association and to vote at the Asso-
ciation's Annual Meetings. However all memberships are welcome to attend the annual reunions. All memberships
are subject to annual renewal except Class A and B Lifetime Members.
Your membership status will not be disclosed at any time except for official Association business.
Membership lists are not provided to any other entity.
 
Class A

Check Box   CLASS A: Shipmate     Any honorably discharged Navy or Marine Corps veteran who served on
      the USS Little Rock at anytime between 1945 and 1976.

Branch of the Service: Navy  Check Box       Marine Corps  Check Box

Dates served on Little Rock: From: ________________     To: _________________

Division(s): _____________   Rank:____________     Plank Owner: Yes Check Box     No Check Box   Year 1945 Check Box    1960 Check Box

Were you on a Decommissioning Crew ? Yes Check Box    No Check Box    If so, what year ?     1949 Check Box     1976 Check Box

Type of Membership: Check Box  Annual ($25.00 per year)      Check Box  Life $100.00 / CL-92  or  $200.00 / CLG-4

Class B

Check Box   CLASS B: Veteran     Any honorably discharged Navy, Marine Corps or Coast Guard veteran who did
      not serve on the USS Little Rock.
  
Branch of  Service: Navy  Check Box      Marine Corps Check Box       Coast Guard  Check Box

Ship(s) served on: _________________________________________________________________________

Dates of Service: From:____________ To:____________  Highest rate / rank achieved:________________

Type of Membership: Check Box  Annual ($25.00 per year)        Check Box   Life ($200.00)
 
Class C

Check Box   CLASS C: Associate     This class open to any applicant, civilian or military.    No Life Memberships in
      this class.  Annual Membership ($10.00 per year).
  
Class E

Check Box   CLASS E: Widow or Surviving Spouse     This class is open to any applicant whose deceased spouse
       served on the USS Little Rock any time between 1945 and 1976 and received an Honorable Discharge.
       No Life Memberships in this class.  Annual Membership ($5.00 per year).

Class F

Check Box CLASS F: Junior Associate     This class is open to any applicant between the ages of 10 to 21.
 No Life Memberships in this class.  Annual Membership ($10.00 per year).

Class F


Based on the above information I am applying for membership in the U.S.S. LITTLE ROCK ASSOCIATION.



____________________________________________________            _________________________
(SIGNED)                                                                                                     (DATE)


Please make all membership checks payable to "USS Little Rock Association".
Please send check and completed Application Form to:

          USS LITTLE ROCK ASSOCIATION
          c/o Frank Berglas
          10 Bayberry Lane
          South Salem, NY 10590-1414

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