PLEASE PROVIDE THE FOLLOWING INFORMATION
NAME________________________________________________________
ADDRESS_____________________________________________________
CITY__________________________________________________________
STATE___________________________ZIP______________________________
TELEPHONE___________________________________________
E MAIL _____________________________________________
FAX ________________________________________________
YEARS ON BOARD: FROM____________ TO________
PLANK OWNER?_________________
DIV/SQDN________________________RANK/RATE_____________
SPOUSE______________________________________________
MIL RET?________________________
RET RANK_______________________
The information provided will be used to
compile a roster book. We will not sell or provide roster information to anyone
outside the ORA, and we do respect your privacy! 