TODAY'S DATE: ___________________________________________________________

NAME: ___________________________________________________________________

STREET ADDRESS: ________________________________________________________

CITY:____________________________STATE: ___________ ZIP: __________________

DATE OF BIRTH: __________________________ PHONE: ________________________

E-MAIL ADDRESS (if you have one): _________________________________________

DEPARTMENT CHOICE: (circle one):

COMMUNICATIONS, ENGINEER, OPERATIONS,

SECURITY, MEDICAL, SCIENCE, COMPUTER OPERATIONS

MEMBERSHIP TYPE:

_____ NEW MEMBER/RENEWAL

The USS Jurassic no longer request dues as part of its membership.

You must be a member of STARFLEET and have the JURASSIC as your primary chapter. Membership allows you to hold positions, ranks, etc. and have full voting rights on all ship policies. Receive Crew Handbook, 12issues of the club newsletter, membership certificate, and Award andRank promotion certificates as earned.

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STARFLEET MEMBERS FILL OUT THE FOLLOWING:

SCC# ____________________________ EXPIRATION DATE: ______________________

If you have just sent in your application to STARFLEET and haven't received your new member packet yet, you won't have th information to fill out the SCC# and EXPIRATION DATE yet. We will need thisinformation as soon as you get it. In the meantime, please tell us the date you mailed your STARFLEET membership application in: __________________

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IF YOU HAVE BEEN A MEMBER OF ANOTHER STARFLEET CHAPTER AND WISH TO TRANSFER TO THE JURASSIC, PLEASE FILL OUT AND SIGN THE FOLLOWING: (If the JURASSSIC is your first STARFLEET chapter, don't fill this out.)

As of the date at the top of this application, I would like to transfer from the ___________________ to the JURASSIC.

SIGNATURE: __________________________ RANK: __________ (please provide a copy of your last rank promotion certificate and you will retain the same rank you had on your former ship.)

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If you have taken any STARFLEET ACADEMY schools, please list them on a separate paper, and send copies of your diplomas.

Download the Jurassic membership form and the Starfleet membership form from our downloads page.