+Annual Dues Form

ANNUAL MADISON ASSOCIATION DUES
Name___________________________________________________________________
Wife’s Name (for Assoc. Membership and/or our records)______________________
Address________________________________________________________________
Phone #___________________________E-Mail________________________________
Yrs. on Board _______________Crew______ Rate/Dept.________________________
Amount Paid $_______________________Yr./Yrs/ Pd. For______________________
Dues are $10 per year. (If not sure, contact Secretary, at secretary@ussjamesmadison627.com, who maintains a current list.) Associate Members (Spouses) are $10 per yr. (We are limited by the IRS to 25% of our membership for Assoc. Members; therefore it is first come, first serve.) If you wish to pay in advance, add $10 for each year and note above.

Make check payable to: USS JAMES MADISON ASSOCIATION, INC.
[b]NEW ADDRESS[/b]
Mail to: Thomas Webber, Treasurer : 45 Mid Valley Dr., New Castle CO 81647
PLEASE REMEMBER, by being a paid member of the Association, you are helping to finance the continuation of the USS James Madison SSBN627 Association and the reunions it sponsors.