CHIEF PETTY OFFICER S CLUB of WNY APPLICATION for MEMBERSHIP

CHIEF PETTY OFFICER’S CLUB of WNY

APPLICATION FOR MEMBERSHIP/RENEWAL

Please check: Renewal_____ New_____ DATE______

NAME______Spouse______

ADDRESS (full)______

E-MAIL______PHONE______

RATE/RANK______SERVICE______

TYPE OF MEMBERSHIP (please circle) LIFE * CHARTER * REGULAR * AFFILIATE

Affiliate membership is available to those who have not served but who possess the core values of this organization

I am interested in serving on one or more of the following committees (please check all that apply:

Constitution Review______Fund Raising/Grant Writing______

Membership______Building & Maintenance______

Public Relations______House/Food & Beverage______

ADDITIONAL DONATIONS

YES! I CAN HELP! Enclosed is my check for the following amount:

$ 50 Bronze____ $100 Silver____ $200 Gold____ $500 Platinum____

Other (Make my dollar count!) $______(amount)

Please make check(s) payable to CPO Club

OR

We can charge your credit card: __Visa __MasterCard __Discover

Card # ______Expires:______

Name on Card:______Phone#:______

Cardholder Signature: ______

Please return this form along with check for membership ($40), and check for contribution to:

Chief Petty Officer’s Club

5 Porter Avenue

Buffalo NY, 14201-1015

Attn: Membership Committee