Name:___________________________
Rating:__________________________ (Captain, AB, Oiler, Messman, 2nd Asst. Engineer, Radio Operator, etc.)
Vessel:__________________________ (one only - your favorite)
Dates served:_____________________
Age at time:______________________

Were you torpedoed?________________
When:____________________________
Where:____________________________

Current Address
Street/P.O. Box:_______________________________________________________
City:_________________ State:__________________ Zip:_________

My tax-deductible contribution of $______________ made payable to AMMMF is enclosed.

Please send to:
American Merchant Marine Museum
300 Steamboat Road
Kings Point, New York 11024