Veterans of the Vietnam War, Inc.        Phone: (570) 547-7900 Post PA-51                                              Fax:     (570) 547-7900 P.O. Box 23                                             Email: [email protected]  Hughesville, PA  17737-0023

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MEMBERSHIP APPLICATION
ELIGIBILITY: Veterans of all eras are welcome and encouraged to join.

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                              PERSONAL INFORMATION
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SOCIAL SECURITY NUMBER
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          LAST NAME                             FIRST NAME                   M. I.
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           STREET                                                      APT. NUMBER
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            CITY                                    STATE         9 DIGIT ZIP CODE
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  AREA CODE PHONE NUM.    DATE OF BIRTH      MARITAL STATUS           DEPENDENTS
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Post Number: _____PA-51______________        Member Type:___________________________
					       WW1,WW2, Korea, Vietnam, Vietnam Era,
					       Gulf, Non-veteran
Membership Date: _______________________  Expiration Date: _________________________
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MILITARY INFORMATION:
        TO CLAIM VETERAN STATUS YOU MUST ATTACH COPY OF DD-214 - DISCHARGE

Branch of Service: _____________________   Date Entered Service: ___________________

Type of Discharge: _____________________   Date Discharged:   ______________________

Service Number: ________________________   MOS: ____________________________________
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I hereby swear to uphold the Constitution                    DUES PAID:______________
of the United States of America and the                 	AMOUNT:_____$16.00*_____
Bylaws of The Veterans of the Vietnam War, Inc.            	RECEIVED BY:____________ 
                                                *LIFE MEMBERSHIP is $200 
						8 monthly installments of $25 each
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