Vietnam Veterans of America Chapter 452 (NJ)MEMBERSHIP
Your best options are to: contact Dennis O'Connor at:
(908) 859-6179
Date: _________________________
VIETNAM VETERANS of AMERICA
APPLICATION FOR MEMBERSHIP
Membership is open to U.S. armed forced veterans who served on active duty (for other than training purpose) 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:________________________________________________________________________
Address: _____________________________________________________________________
City: ___________________________________ State: _________________ ZIP: ___________
Home Phone: __________________________________ Work Phone: _________________________________
e-mail: ______________________________________________________
Date of Birth: _____________________________________ Gender: Male Female
Optional: Chapter No. ____________________ Sponsor: __________________________________________
I am already a VVA member and would like to become a life member. My current VVA Member number is: ________________
Type of Membership:
Individual Member – 1 year: $20 Life Member – Ages 50-55: $225
Individual Member – 3 year: $50 Life Member – Ages 56-60: $200
Life Member – Ages 61-65: $175
Life Member – Ages 66+: $150
Optional Life Member Time Payment Plan - $50 down, $25/month (until age bracket is paid in full)
Payment Method: Check Money Order Credit Card (Visa, MasterCard, American Express. Discovery)
Checks Payable to VVA
Credit Card Number: ____________________________________ Exp. Date: _________________________
Signature: ______________________________________________________
Return your completed application with payment and a copy of your DD Form-214 to:
Vietnam Veterans of America
P O Box 64299
Baltimore, MD 21264-4299
Revised 08/2009
