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

Payment Method:
____ Check ____ Money Order
Credit Card:
____ VISA ____ Master Card ____ Discover ____ American Express

Credit Card Number: ______________________________________

Expiration Date:___________________________________________

Signature: _______________________________________________

*Associates of Vietnam Veterans of America Chapter #949 meet the fourth Tuesday
of each month except in December.  We are privileged to hold our meeting in the
meeting hall of American Legion Post #16 located at 1421 6th Avenue, Huntington,
WV 25701 at 6:30 PM. Refreshments.
Associates of Vietnam Veterans of America
Membership Application
Send application with dues payment to:
Larry Blankenship. Sec/Tres
1215 Charleston Ave., Huntington, WV 25701
Make checks payable to: VVA 949
Please do not send cash