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Please print out, fill in, and mail with your check to:

                            Sea Service Leadership Association

                                  Attn: WSC Associates, LLP

                                     Post Office Box 471212

                                      Forestville, MD  20753

 

                         Membership Application Form

 

Text Box:   Text Box:                                                                  Renewal                                    New Member

 

Date:  ___________               Rank:  ___________               Name:  __________________________

 

Text Box:   Text Box:   Text Box:   Text Box:   Text Box:   Text Box:   Service:            USA                    USN                      USMC               USAF                   USCG           Other

 

Text Box:   Text Box:   Text Box:   Text Box:   Text Box:   Status:              Active Duty        Reserve                Retired             Civilian                 Student

 

Text Box:   Text Box:   Text Box:   Text Box:   Text Box:     Source of Commission:         Service Academy         ROTC             OCS/AOCA           OIS               Other ____ 

 

Mailing Address:    __________________________________          Home Phone:  ________________

 

                              __________________________________          Email:  ______________________

 

                     City:  _________________ State:  ___________          Zip Code:  ___________________

 

Current Job Title:   __________________________________          Work Phone:  ________________

 

Work Address:        ________________________________             Fax:  ____________

 

                               ________________________________             Email:  ______________________

 

                     City:  _________________ State:  __________            Zip Code:  ___________________

 

                                      Interested in running for an Office/Position?                  Yes            No

Could you volunteer for one of these committees?

 

Text Box:   Text Box:   Text Box:            By-laws                                                   Budget                                     Command Point of Contact    

Text Box:   Text Box:   Text Box:            Elections                                                Historian                                 Membership

Text Box:   Text Box:   Text Box:            Newsletter                                              Midshipman Liaison                Awards          

Text Box:   Text Box:   Text Box:            Programs                                                Publicity                                  Symposium

 

Permission to include your name and address in SSLA Membership Directory?  Yes          No

 

Yearly Dues Schedule

 

Membership Category (Please check one)

Regular (Voting) Member:   (Active, Reserve or Retired) Navy, Marine Corps, Coast Guard, NOAA Officers

 

Text Box:          0-6 and above                                                                                     $50.00

Text Box:          0-5 and 0-4                                                                                          $45.00

Text Box:          0-3, 0-2, 0-1, Warrant Officers and E-6 – E-9                                 $30.00

 

Affiliate (Non-Voting) Member:  (Active, Reserve or Retired Officers of other services and Civilians (both GS and Regular):

 

Text Box:          0-6 and above / GS 15 and above / Other Civilians                         $40.00

Text Box:          0-5 and 0-4 / GS 12 – 14                                                                     $35.00

Text Box:          0-3, 0-2, 0-1, Warrant Officers / GS 11 and below                            $25.00

       Midshipmen / All ranks living outside Washington DC Area           

                                                                 

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