1. Name        * Required Field

2. Address 

3. City         

4. State      

5. Zip Code   

6. Telephone 

7. E-mail Address 

8. Spouse Name   

9. I am current with my dues  Yes    No

10. I would like to reactivate for another year  Yes   No

      Check the box and forward your annual dues to the address below. If it is now Jan-Jun, submit
      $20.00. Jul-Dec, submit $10.00. Annual dues of $20.00 is collected each January.

      USS Berkeley Association
      6318 S 20th Street
      Milwaukee, WI 53221

11. Comments: Optional