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APPLICATION FOR MEMBERSHIP / RENEWAL (Please print legibly or use a return address label)




NAME:________________________________________ LAST FIRST MI

ADRESS: ________________________________________

CITY: _____________________STATE:___ ZIP: _________


PHONE:_____________________SPOUSE: ______________

BIRTHDATE: ________ON BOARD FROM _____ TO _____

Div/Squadron/Unit/etc. While Aboard: _____________


SIGNATURE: __________________________DATE:________

ENCLOSE $10 - Payable to USS FDR Reunion

Mail to:

USS FDR Reunion

c/o Robert Siefker

3968 Honey Creek Blvd

Greenwood, IN 46143

You are eligible for membership if you served aboard the FDR in any capacity i.e. ship's company, air group/squadrons, embarked flag, or special detachments.

In short, If you walked the decks of the FDR, we invite you to join We are bound together by the one thing that touched all of our lives - service aboard "Rosie,".

Dues are $10.00 per year payable by Dec 31st each year.

Applications for new membership received after July 1 will expire

Dec 31 the following year.

Please fill in all blanks on the Application Form so that we have accurate information for our newsletter mailing list.

(Feel free to use a return address mailing label but make sure email and phone are included.)