Membership Form
Please print out and send this form to:
Please forward form to:
U.S.S. Macon Veteran's Association
C/O Bill Hossler
28 Mill Valley Road
Pittsford, NY 14534-3904

Name:___________________________________________________

Address:_________________________________________________

City/Town:___________________ State: _______ Zip Code: ________

Telephone: __________________    Email: _______________________

2011 Dues: ($20.00) ____________

2012 Dues: ($20.00) ____________

2013 Dues: ($20.00) ____________

Donations:  ______________

For new members please indicate year(s) you served on board the
USS Macon: _____________  Division: ______________

(2011 dues are from January 2, 2011 to December 31, 2011) 
Dues are due January 2, 2011.

Please check your mailing label on the newsletter, the date indicated after your name reflects the year that your dues is paid through.
Please notify Ted Parker if the date posted is incorrect.

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