U.S.S. CONYNGHAM Association
Membership Sign-up Form

Personal information:
Address 2:
City: State: ` Zip:

Ship Served on: DD-371 DDG-17
Shipboard Rate/Rank:
Years on board (i.e. 63 – 66):

E-mail: E-mail 2:

Phone Number: Phone Number 2:

Mail form and $17.00 fee to:
John Gosper
4516 Prince Albert Way
Lexington, KY 40515-4748

Please do not send cash or send dues to anyone other than the Association Treasurer.

Personal checks or money orders should be made out to “USS CONYNGHAM Association”.