Name:
Address1:
Address2:
City:	State:
Zip/postal code:	Country:
Date of Birth:	Sex Male/Female:
Home phone:	Work phone:
e-mail:
Spouse's Name:
Chapter #:	Sponsor:
Membership Type (select one):
Annual	1 year @ $20.     3 year @ $50.
or Life	age 49 and under @ $250 ages 50 - 55 @ $225 ages 56 - 60 @ $200 ages 61 - 65 @ $175 ages 66 and over @ $150   Check here for payment plan of $50 down and       the balance payable at $25/month.
Payment Method	Check   Money Order Visa   MasterCard
Card No.	Exp.Date:
Signature	____________________________________ Date:
Please fill in the form online and print it on your printer, then either mail it to the address shown above. Please be sure to include a copy of your DD-214.

If you wish to join by mail, Fill Out this form (on-line), print it, and mail it with a copy of your DD-214 to:

Vietnam Veterans of America Chapter 452 P.O. Box 999 Flemington, NJ 08822

 

VVA Membership Application