Vietnam Veterans of American - Membership Application

Fill out completely for prompt processing, and include a legible copy of your DD-214 if you are a Veteran who served from January 1, 1959 through May 7, 1975.

Please PRINT and mail to:
Membership
VVA Chapter 154
16945 12 Mile Road
ROSEVILLE MI 48066

Name: __________________________________________

Street: __________________________________________

City: ______________________ ST: ___ Zip: __________

Ph# (W): ___________________(H)_____________________

Date of birth: ___/___/19____ Age: ____ Social Security#:________________

Vietnam Era Veteran ___ DD214 Attached _Yes _No (If DD214 is NOT attached, your application will NOT be processed!)
A Vietnam Era Veteran is a person who was in the military service between January 1, 1959 through May 7, 1975.

Associate Member ___

Method of Payment
Check/Money Order No. ________ Amount $ _________
Credit Card Amount $ _________
Credit Card Number: ______________________________
Expiration Date: ____________

______ Please send me information about LIFE membership

_________________________________________________
Signature

VVA membership year is 12 month period of March 1st to February 28th. Individuals who join after September 30 of any membership year are automatically enrolled through the next full membership year. Annual dues are $20.00, Life Membership is $250.00.

All checks or money orders are to be US funds. No CASH please! Make check or money order payable to: VVA Chapter 154

OPTIONAL — New Member Survey

Please answer the following questions so that we may learn a little about you, and how to better serve you and our other members. All responses are kept confidential, and they are OPTIONAL.

1. How did you learn about VVA? (Optional)
___ a copy of the Veteran
___ a copy of a local chapter newsletter/flyer
___ a copy of a State Council newsletter/flyer
___ an item in the local media
___ from a friend
___ from a VVA member
___ other

2. Do you belong to other veterans' organizations? (Optional)
___ No ___ Yes (if YES, please list)
A. ______________________________________
B. ______________________________________
C. ______________________________________

3. What do you believe are the most important issues facing Vietnam veterans? (Optional)
___ Vietnam specific health issues (Agent Orange, PTSD)
___ Veteran's health care in general
___ Employment and economic concerns
___ Homelessness
___ Substance abuse
___ POW/MIA
___ other _________________________________

4. Personal (Optional):
A. Martial status: __Married __ Single __ Divorced
B. Education: __less than 12 years __ High School Graduate __1-4 College __ College Graduate
C. Job Title ___________________________________________________

D. Annual income (Optional):
__ under $10,000 __ $10,000-$25,000 __ $25,000-$50,000
__ $50,000-$75,000 __ $75,000-$100,000 __ over $100,000

Thanks for your cooperation, and Welcome Home!


For additional information e-mail: vvaadm@ameritech.net

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Update: March 24, 2011