SURFACE NAVY ASSOCIATION MEMBERSHIP APPLICATION
Please Note:  If this is a RENEWAL, you only need to complete required fields shown in RED and payment fields. If any other information has changed, please update those fields at the time of renewal.
 
Application Type:   Rank/Title:                    Status: 
 
First Name:   M I :      Last Name:       Suffix:       Branch: 
 

PRIMARY CONTACT INFORMATION

Please include Organization/Command in address info if required by Post Office for mail delivery. 
Not required for home addresses.
Mailing Address Line 1:      Mailing Address Line 2: 
 
                                 City:                 State:                       Zip Code: 
Home Telephone: Work Phone Number:  
 

**We do not require 2 email address but highly recommend that you provide a work and personal email if possible. 
This ensures that you receive updates if you PCS or your command/organization has a firewall.  Thank you!
   
Primary E-Mail Address:            

Alternate Email Address: 

   
Chapter Affiliation:                                    Non Affiliated:
   

EMPLOYMENT INFORMATION
   
Current Duty Station/Employer:                                    Position/Billet: 
   

MEMBERSHIP FEES
   

                            

  Please enter Promotion Code if applicable:   
     

Active Duty & Reserves

ANNUAL

THREE YEAR
  O-7 & Senior $30.00 $75.00
  O-6 $25.00 $62.50
  O-5 $20.00 $50.00 
  O-4 $20.00 $50.00 
  O-3 $15.00 $37.50
  O-2 $15.00 $37.50
  O-1 $15.00 $37.50
  CWO $15.00 $37.50
  Midshipmen/Cadets   $15.00
  E7/E9 $15.00 $37.50
  E6 and Below  $10.00 $25.00 
  Retired (any rank) $25.00

$62.50
  Civilians  $25.00

$62.50
       

LIFE MEMBERSHIP DUES
(Contact navysna@aol.com for Payment Plans!)

Please enter Date of Birth:

                                        Active Duty and Drilling Reserve to age 50

 $350

                                    Active Duty and Drilling Reserve after age 50

 $250

                                                         Retired or Civilian Under Age 40

 $450

                                                   Retired or Civilian Age 41-50

 $350

                                                   Retired or Civilian Age 51-60

 $250
                                                           Retired or Civilian Over Age 61 $150
   
                                             Sponsored By:   
 
If this is a Gift Membership:  Please indicate who it is from: 
   

PAYMENT INFORMATION
 
Credit Card:                                                       Credit Card Number:           
 
Expiration Date:                                                 Name as it appears on CC: 

TOTAL PAYMENT:  $                         

Surface Navy Association            2550 Huntington Avenue, Suite 202              Alexandria, VA   22303           1-800-NAVYSNA