Associate Mesquite VVA Membership
Associates of Vietnam Veterans of America Membership Application
Send Application with dues payment to:
VVA Mesquite
Chapter 993
P O Box 2431
Mesquite, Nevada 89024-2431
Make checks payable to AVVA
Please do not send cash
_____________________________________________________________________________
Name ________________________________________________________________
Address ______________________________________________________________
City____________________________State__________________ Zip ____________
Phone ____________________ E-mail _____________________________________
Date of Birth _____________________ Male/Female (Check one)
Dues: (Check One)
____ One Year $20
____ Three Years $50
____ Life Membership, age 49 and under: $250
____ Life Membership, ages 50 to 55: $225
____ Life Membership, ages 56 to 60: $200
____ Life Membership, ages 61 to 65: $175
____ Life Membership, ages 66 +: $150
____ Life Membership, time payment plan: $50 down, then $25 monthly
(For time payment plan, please be shure to include your date of birth)
Payment Method:
____Check ____Money Order
Credit Card:
____VISA ____Master Card _____Discover _____ American Express
Credit Card Number ____________________________ Exp Date ___________
Signature _________________________________________