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:
David Johnson
12330 Peach Orchard Dr
Jacksonville, FL. 32223

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”.