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