| NAME:____________________________________BIRTHDATE:___________________ NUMBER/NAME OF
SHIP:____________________________________WIFE'SNAME:___________________
SERVICE(Navy or Coast
Guard):_________________________________________________________________
RATING,RANK& Dates of
Service:________________________________________
HOME
ADDRESS:___________________________________________________________
____________________________________________________________________
Zip code necessary for
mailings):___________-______
TELEPHONE,HOME: AC(____)___________
e-mail__________________
DUES ENCLOSED($20.00 for 1 year):_________________
Send To: United States LST Association
P.O. Box 167438
Oregon, Oh. 43616-7438
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