Application For Membership

Vietnam Veterans of America

Application for Membership

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 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 along with this application and dues payment.

Name:_____________________________________________________________Nickname:___________________________________________________

Address: ___________________________________________________________________________________________________________________________

City:________________________________________________State:___________________________Zipcode:___________________________________

Home Phone: _________________________________Work : _________________________________Cell : ___________________________________

email: _____________________________________________________ Date of Birth: ______________________________ 

Optional:  Chapter No: _____________________   Sponsor: ___________________________

Membership:  Life Member - $50.00

I am already a VVA member and would like to become a life member. My current VVA number is: ____________________________

  Payment Method: [___] Check or Money order: Make check or money order payable to Vietnam Veterans of America Chapter 1046.   

Return your completed applicationwith a copy of your DD Form 214, check, money order: