Vietnam Veterans of America, Inc.
MEMBERSHIP APPLICATION

NAME:__________________________________________________________

ADDRESS:_______________________________________________________

CITY,STATE,ZIP:________________________________________________

MAILING ADDRESS (if different from above):

________________________________________________________________

TELEPHONE No.(____)_______________________

PAGER No.(____)___________________

FAX No.( ___)_____________________

E-Mail Address: _________@____________________
______ I am a Vietnam Veteran
______ I am not a Vietnam Veteran (I am applying for Associate
membership)
______ Enclosed is payment for 1 year membership :$20.00
______ Enclosed is payment for 3 years membership: $50.00
______ Life Membership
($250 - 49 and below; $225 - 50-55; $200 - 56-60; $175 - 61-65; $150 -
66 & over; $50 & 8 payments)

Payment can be in the form of cash, check, or money order payable to : V V A Massachusetts State Council or selected chapter

If you are transferring to a another chapter please include membership card number #____________________

Print this application form and mail a copy to your local chapter addresses located in the Chapter Listings or to:

V V A Mass State Council Membership
9 K Street
Turners Falls, Massachusetts 01376-1408

If you are applying for membership as a Vietnam Veteran be sure to include a copy of your DD214 along with this printed form and your payment for one, three years, or life membership.

Welcome Aboard, Welcome Home!!! and Thank you for your support!!!