Application to Join

of the United States Coast Guard

Date _______________

Name _______________________________________________________

Mailing Address ______________________________________________

City, State, Zip ______________________________________ _________

Telephone _____ ______ __________ Cell Phone _______ _______ ____

Fax ___________________

Email ______________________________@________________________

Spouse/Friendís Name__________________________________________

How did you hear about us?______________________________________

Are you:

a) Active Duty ______ Present Unit __________________ Rate/Rank ____

b) Retired ___ Year of Retirement _____ Last Rate/Rank at Retirement _____

c) Former Coastie (didn't retire) _____ Last Rate/Rank attained ______

Units served on/at in which you served in Alaska with dates

___________ __________________________________

___________ __________________________________

___________ __________________________________


Mail Application and your $20 Annual Dues to:
Doak Walker - PO Box 33523 - Juneau AK 99803
Res 907 789-2579, Cell 907 209-2004

Please check applicable Membership desired:

Regular* _____ Associate** _____

* Regular membership in the BERING SEA PATROL-ALASKA VETERANS Association
shall consist of:
(A) Those persons who sailed in the Bering Sea as members of the U. S. Coast Guard
and former or active members of the U. S. Coast Guard who sailed in the Bering Sea subsequent
to their release from the Coast Guard.
(B) Retired, active and former members of the U. S. Coast Guard who served on active duty in
Alaska (17th Coast Guard District) for a continuous period of twenty-one (21) days
and/or qualify to wear the Coast Guard Arctic Service Medal for duty in Alaskan waters.
(Revised, 26 Sept 1998) (Revised, 17 Sept 2000)
(September 2004 in Niagara Falls)
** Associate membership is available to any others interested in joining us.