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


Personal information:
Name:
Address:
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
119 Homestead Dr.
Nicholasville, KY 40356


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”.