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Membership Application

Date of Birth _________________   Sex  M  F
Home Phone (______) _______________________
City_______________________________  State _________
Work Phone (______) ________________________
E-mail ______________________  work/home

Chap # ______ (if known) Sponsor: _________________

I'm not a Vietnam veteran, but I want to help Vietnam vets and their families.
Please accept my donation:     $10     $20     $50      Other $______

Eligibility:    Vietnam and Vietnam-era veterans who served on active duty in the U.S. military (for other than training purposes) between February 28, 1961 and May 7, 1975 (in-country Vietnam), or between August 5, 1964 and May 7, 1975 for Vietnam-era veterans.  Return this application along with a copy of your DD Form 214.

Term: 1 year - $20 

  3 Years - $50 

Life membership: $250 (ages 49 and under) $225 (ages 50-55)
$200 (ages 56-60)           $175 (ages 61-65)
$150 (ages 66 and over)
Optional life membership time payment plan - $50 down, $25/month
Payment Options:  Check   Money Order  Credit Card (Visa, MC, Amex)

Credit Card # __________________________________ Exp Date ____/____

Signature __________________________________ Date ______________

I am a spouse/family member or friend of a Vietnam Vet and would like membership information on Associates of Vietnam Veterans of America.


Print this application and mail to:    Vietnam Veterans of America
P.O. Box 2812
San Angelo, TX 76902

VVA is a non-profit, veterans service organization.  Programs and services are funded by member dues and public donations.

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