| Membership is open to U.S. armed
forces veterans who served on active duty (for other than training
purposes) in the Republic of Vietnam between February 28, 1961 and May 7,
1975, or in any duty location between August 5, 1964 and May 7, 1975.
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APPLICATION FOR
MEMBERSHIP |
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ATTENTION: New members
and new life members
You must submit a copy of your DD Form -
214 form
along with this application and dues payment.
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| Name: |
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| Address: |
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| City: |
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State: |
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Zip: |
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| Home Phone: |
Work Phone: |
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| E-Mail
Address: |
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| Date of Birth: |
Sex: |
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| Optional: |
| Chapter No. |
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Sponsor: |
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___ I am already a
VVA member and want to become a life member.
My VVA Member number
is ______________ . |
| Type of
Membership: |
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Life Member-Ages 49
and Under : $250 |
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Individual Member -1
year: $20 |
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Life Member-Ages
50-55: $225 |
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Individual Member- 3
years: $50 |
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Life Member-Ages
56-60: $200 |
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Life
Member-Ages 61-65: $175 |
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Life Member-Ages 66+:
$150 |
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Optional Time Payment
plan- $50 down,
$25/month | |
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| Payment
Method: |
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Check |
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Money Order |
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Credit Card (Visa,
Mastercard, American Express, Discover) |
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Credit Card Number: |
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Exp.
Date: |
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Signature: |
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| Return your
completed application, payment, and a copy of your DD Form-214
to: |
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Vietnam Veterans of America
Chapter 835
P.O. Box 6281
Yuma,
AZ 85365 | | |
