|
| 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. |
| |
|
APPLICATION FOR MEMBERSHIP
|
|
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.
|
| Name: |
___________________________ |
|
|
| Address: |
___________________________ |
|
|
|
___________________________ |
State: |
_____________ |
| City: |
___________________________ |
Zip: |
_____________ |
|
|
|
|
| Home Phone: |
___________________________ |
Date of Birth: |
_____________ |
| Work Phone: |
___________________________ |
Sex: |
_____________ |
| E-Mail Address: |
_____________________________________ |
|
| Chapter
No. |
___________________________ |
Sponsor: |
________________________ |
|
(Fargo Chapter is 941) |
|
(Optional) |
|
|
___ I am already a VVA member
and want to become a life member.
My VVA Member number is ______________ .
|
| 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 (Circle type: Visa,
Mastercard, American Express, Discover) |
| |
|
Credit
Card Number: ___________________________ |
|
| |
|
Exp. Date:___________________________ |
|
| |
|
Signature: ___________________________ |
| Return your completed
application, payment, and a copy of your DD Form-214
to: |
|
To join the Fargo
Chapter:
Dave Rice
2610 76 Ave N
Fargo ND 58102-6107
(Contact
me for additional information.)
|
Membership at large:
Vietnam Veterans of America
P.O. Box 64299
Baltimore, MD 21264-4299 |
|
|
|
|
|
|
|
