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: 
   

SCHOLARSHIP DONATION

Yes I would like to make a donation to the SNA VADM Robert Walters Scholarship Fund
Amount: $

 

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

TOTAL PAYMENT:  $                                  

Surface Navy Association     6551 Loisdale Court, Suite 222     Springfield, VA   22150    1-800-NAVYSNA