| 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 ______________ .
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| 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 Tucson Chapter 106
P.O. Box 40903
Tucson, AZ 85717-0903
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