[Print this page; fill out the form; then mail to the address at the bottom.]

I would like to be a sponsor of the model of the USS Canopus. I would like my name and rate/rank on the Plank Owner’s Certificate to read:

First then Last Name , Rate/Rank

 [  ]  In addition, I would like to include "In memory of, From ______________________________________ "

The certificate will be mail to you, please note your address below:

Street: ___________________________________________________

City: _____________________________ State: ____ Zip: _________

Model will become the property of the USS Canopus Association and be on permanent display at the St. Marys Submarine Museum near Kings Bay, GA.

For more information, feel free to call me at 503-689-1712.

Please make check payable for $100 (minimum) to “Richard Retin”. Mail to me at:

Richard Retin

2245 Wintercreek Way SE

Salem, OR 97306