Membership Application

Name: ___________________________________________

Address: _________________________________________

City: ____________________________________________

State: __________ Zip: ___________ Country: __________

Date of Birth:___/___/___ Sex: __Male __Female

Home Phone: (_____)_______________

Work Phone: (_____)_______________

Spouse's Name: ___________________________________

Chapter No. 751   Sponsor: __________________________

Membership Type (select one):

___Individual Member ---- Vietnam-era veterans who served on active duty for other-than purposes between August 5, 1964, and May 7, 1975. Return this application along with a copy of your DD-214.

___Associate ---- All veterans, family members, friends, and the general public.

Term and Payment Preference (select one)

___1 year ---- $20.00   ___3 years ---- $50.00

Life Member (select age group)

  • ___age 49 and under ---- $250.00
  • ___ages 50 - 55 ----$225.00
  • ages 56 - 60 ---- $200.00
  • ages 61 - 65 ---- $175.00
  • ages 66 and over ---- $150.00

    ___Full Payment

    ___Monthly Payment Plan ---- $50.00 down, $25.00/month

    ___Monthly Coupons

    ___Bill Credit Card

    VVA is a nonprofit organization. Programs ans services are funded by member dues and donations. No funding is received from the federal government.

    Please accept my donation: ___$10. ___$20. ___$50.  ___ other $_____

    Payment Method:

    ___Check   ___Money Order   ___Visa   ___Master Card

    Card No. __________________________ Exp. Date ____/____

    Signature: ______________________________ Date: _________

     

    Return this application along with dues payment to the address listed below,

    VVA Chapter 751
    P.O. Box 2483
    Lawton, OK.  73502

    VVA appreciates your support