USS Howard W. Gilmore (AS-16) Memorial Association
Members Information Form
Member's Name: __________________________________ Wife's Name: _______________
Street ___________________________________________________
City ____________________________________________________
State ________________________ Zip Code ____________________
Check box for change of address [ ]
Home Phone: ________________________
E-mail Address: ___________________________________________
I was in Department _______________________ Division _________
Date reported for Duty: _________ Transferred Date: _______ Rate/Rank: _________________
$_____________ Annual dues, $10.00 per year.
$_____________ Donation for the Reunion Hospitality Room fund. $_____________ Hat, Type _______, $16.00 includes shipping. See: Memorabilia Photos
$_____________ Total enclosed.
Make check payable to: Gilmore Memorial Association, and mail to:
Secretary/Treasurer:
Gilmore Memorial Association % Bob Munjas, 440 W. 40th St Shadyside, OH. 43947
Phone: 740 676 5582 moonmunj3@aol.com
Notes: If you would like one of our hats, the cost is $16.00, which includes shipping. Orders for shirts or name tags will be taken at the next reunion. Please fill out the above information form at your convenience and return to me. Please contact me if you have any questions.
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