Vietnam Veterans of America Associates |
Application
for Membership |
Name____________________________________________________________________ |
Address__________________________________________________________________ |
City______________________________________State___________Zip______________ |
Phone__________________________Affiliated with Chapter#_______________________ |
|
One
Year @ $20.00______ Three
Years @$50.00______ |
Life
Membership (select age group and payment preference) |
_____Age
49 & under $250.00 _____Age 50-55 $225.00 |
_____Age
56-60 $200.00 _____Age 61-65 $175.00 |
_____Age
66 and over $150.00 |
_____Monthly
coupons _____Bill Credit Card |
|
Payment
Method |
_____Check
_____Money Order _____Visa _____Master Card |
Signature_________________________________________________ |
_____Check
here if your are eligible to be a member in |
Print
and mail to: AVVA Membership Affairs, |
|