USS BENJAMIN FRANKLIN
				    (SSBN 640)
				    Association

			       Membership Application



As a former submariner who served aboard the nuclear powered US Navy submarine USS Benjamin Franklin 
(SSBN 640) between 1965 and 1993, or a family member of a former SSBN 640 submariner, the Executive 
Committee of this Association hereby extends to you an invitation to apply for membership in the USS 
Benjamin Franklin (SSBN640) Association.  

The following membership options are available to you:

	Regular Member: 		_______    $20.00 per year (due annually by January 1st)	

	Lifetime Regular Member:	_______    $150.00  (One-time Membership Fee)


Please make your check payable to:  	USS Benjamin Franklin Association

Mail application with check to: 	Allen "Lenny" Exelby, Membership Chairman
					110 Meriden Drive
					Newark, DE 19711


Any Questions? Call Len at (856) 816-5672 or
E-mail him at ssbn640blueyeo@aol.com

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Full Name: 						  Highest Rank & Position on the Franklin: 			


Other family members to be included in this membership:  								


Dates served aboard the Franklin:  From: __________   To: __________   Your Date of Birth:  _________________  


Crew  (check all that apply):  

(    ) Blue           (    ) Gold           (    ) Commissioning           (    ) Inactivation         (    ) Conversion/Refit



Note:  If you served on more than one crew during your tenure aboard the Franklin, please indicate here the years you served on each:


(Blue): _______________________  (Gold): ________________________  (Other): _____________________________         

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Mailing Address: 					                                 					

Phone No:				E-mail address: 							

Date Submitted:				Membership Number (to be assigned):