ATTENTION: Membership in Vietnam Veterans of America 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. You must submit a copy of your DD-214 with this membership application. |
Name: |
|
|
|
|
|
|
|
|
Address: |
|
|
City: |
|
State: |
|
Zip: |
|
Home Phone: |
Work Phone: |
|
E-Mail Address: |
|
|
Date of Birth: |
Sex: |
|
|
Optional: |
Chapter No. |
|
Sponsor: |
|
___ Check here if you are a member of Vietnam
Veterans of America, or if you are a
Vietnam-Era Veteran. |
| Type of Membership: |
| |
|
|
Life Member-Ages 49 and Under :
$250 |
| |
Individual Member -1 year: $20 |
|
Life Member-Ages 50-55: $225 |
| |
Individual Member- 3 years: $50 |
|
Life Member-Ages 56-60: $200 |
| |
|
|
Life
Member-Ages 61-65: $175 |
| |
|
|
Life Member-Ages 66+: $150 |
| |
|
|
Optional Time Payment plan- $50
down, $25/month |
|
|
Payment Method: |
|
|
Check |
|
|
Money Order |
|
|
Credit Card (Visa,
Mastercard, American Express, Discover) - Please circle correct type of card. |
|
|
Credit Card Number: |
|
|
|
|
|
Exp.
Date: |
|
|
|
|
|
|
Signature: |
|
| |
| Return your completed application,
payment, and a copy of your DD Form-214 to: |
Vietnam Veterans of
America
VVA 905 of Porter County to the attention of the Membership Chairman
P.O. Box 1104,
Portage, IN. 46368 |
|
|