Viet Nam Veterans of America Mesquite, Nevada, Chapter 993

"Never again will one generation of veterans abandon another"
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Print Friendly and Downloadable Mesquite VVA Applications

 

 
MEMBERSHIP APPLICATION
Membership is open to U.S. armed forces veterans who served on active duty (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.

 

            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 _____________________________________________________________________

 

City _________________________________________________________________________

 

Home Phone __________________________ Work Phone __________________________

 

Email Address _______________________________________________________________

 

Date of Birth __________________________ Sex __________________________________

 

(OPTIONAL) Chapter number _______________ Sponsor ___________________________

 

                  ( ) I am already a VVA member and want to become a life member.

                      My VVA Member number is ________________________

Type of membership:

  ( ) Individual Member - 1 year:  $20     ( ) Life Member - Ages 49 and under:  $250

  ( ) Individual Member - 3 years: $50     ( ) Life Member - Ages 50 - 55: $225

                                                              ( ) Life Member - Ages 56-60: $200

                                                              ( ) Life Member - Ages 61-65: $175

                                                              ( ) Life Member - Ages 66 +: $150

                

                          ( ) Optional Time Payment plan - $50 down, $25 monthly

 

Payment Method:

            ( ) Check   ( ) Money Order  ( ) Credit Card (Visa, Mastercard, Amex, Discover)

 

 Credit Card Number: ___________________EXP. DATE:______   

 

Signature ______________________________________________

 

Return completed application to VVA Mesquite Chapter 993 / P O Box  2431/ Mesquite, NV 89024-2431