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USS THOMAS C. HART (DE/FF-1092)
VETERANS ASSOCIATION MEMBERSHIP FORM
(This form should print for you when you click your printer function - Please print
the form, complete, and mail to address listed on the form,
If a shipmate told you about the TCHVA,
please tell us his name:____________________
First Name _______________________
M.I. ____ Last Name _______________________
Rate/
Rank on TCH _____________________ Division _____________________
Year Reported Aboard_____________ Year Detached________________________
Street Address: _____________________________________________________________
City_______________________________________ State_______ Zip ________________
Home Phone _________________________ Cell/Work Phone_______________________
Spouse Name: ________________________________________
Current Email Address: _____________________________________________________
Dues are only $10 per year. We have chosen to collect for
two years($20) at a time to reduce the administrative burden on our all volunteer staff. Thanks for your
understanding and support. You may join for any additional years if you desire.
Please circle years:
2007/2008
2008/2009 2009/2010 2010/2011
Please mail check/M.O. to: USS THOMAS C. HART VETERANS ASSOCIATION
c/o Randy Groen
2219 Friendship Ln.
Burnsville, MN 55337
“YA GOTTA HAVE HART”
NOTE: IF YOU HAVE DIFFICULTY PRINTING FORM,
PLEASE JUST WRITE INFO ON SHORT NOTE AND INCLUDE WITH YOUR PAYMENT! WE'LL MAKE SURE WE MUSTER YOU IN! THANKS
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