VETERANS OF THE VIETNAM WAR, INC.
805 South Township Boulevard
Pittston, Pennsylvania 18640-3327
Phone: 570-603-9740 Fax: 570-603-9741 1-800-VIETNAM
E-mail: [email protected] WebSite: www.vvnw.org
"All Military – All Veterans - Welcome"
MEMBERSHIP APPLICATION
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GENERAL INFORMATION:
________-_____-________ Social Security Number |
I hereby swear (affirm) to uphold the Constitution of the United States and the Bylaws of the Veterans of the Vietnam War, Inc. _______________________________ Signature |
PLEASE
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____________________________________ ______________________________ _________ Last Name First Name Middle __________________________________________ _______ _______________________________ Street Apt. Number E-mail Address __________________________________________ __________ __________-________ City State Zip Code + 4 ( ) _________ - ________________ _______________ Telephone Number Date of Birth |
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MILITARY DATA:
TO CLAIM VETERAN STATUS YOU MUST ATTACH A COPY OF DD-214 (DISCHARGE FORM) |
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