Please Print and Mail Form
| Name: | Zip: |
| Address | State: |
| City: | Telephone: |
| Email Address: | |
| Relationship to USS Indianapolis Story: | |
Please check one of the following
| Name/Address Change | |
| New Membership | |
| Other |
Membership Contributions
| $25 per individual (2 year membership fee) | |
| Other: Any amount received above $25 will be considered a donation, and will be greatly appreciated! |
Please make checks payable to the Second Watch Organization
Submit this form and your dues to:
Second Watch Treasurer
Ray Heerdt
6292 Greenway Drive SW
Grand Rapids, MI 49546
*Please make copies of this form and complete for each additional family member joining