Name_____________________ Rate____________

Address__________________________

City, State, Zip______________________________________________

Telephone (with area code)________________________

E-mail address____________________________________

Spouse's Name_________________________________

Years served aboard the Guadalupe___________________________

How did you hear about the reunion Association?________________________

Annual Dues - $15.00

Please mail to:

USS GUADALUPE REUNION ASSN

C/O DENNY CROWDER

8799 N CO RD 650 WEST

BRAZIL IN 47834-9387