Text Box: Associates of Vietnam Veterans of America
Membership Application
Send application, with dues payment, to:
Joe Wilson Sec/Tres
4608 Magazine Ave. Huntington WV 25704
Make checks payable to VVA 949
Please do not send cash.
Name: _________________________________________________________________
Address: _______________________________________________________________
City: _____________________________ State: ________________ Zip: ___________
Phone: ________________________ E-mail: __________________________________
Date of Birth: ___________________ Male / Female: (Circle One) Chapter # 949
Sponsor: ______________________________________________________
Dues: (Check One)
____ One Year: $20
____ Three Years: $50
____ Life Membership, age 49 and under: $250
____ Life Membership, ages 50 to 55: $225
____ Life Membership, ages 56 to 60: $200
____ Life Membership, ages 61 to 65: $175
____ Life Membership, age 66 + : $150
____ Life Membership, time payment plan: $50 down, then $25 per month
(For the time payment plan, please be sure to include your date of birth.)
Payment Method:
____ Check ____ Money Order
Credit Card:
____ VISA ____ Master Card ____ Discover ____ American Express
Credit Card Number: ____________________________________ Expiration Date: ______________
Signature: __________________________________________