| THEY’RE A HANDFUL OF THE PEOPLE WHO MAKE UP VIETNAM VETERANS OF AMERICA IN KANSAS.
THEY’RE VETERANS, FAMILY, AND FRIENDS, AND
THEY INVITE YOU TO JOIN THEM.
| MEMBERSHIP APPLICATION
Last Name: _________________________ First Name: ____________________ Initial: _____
Address: _______________________ City: _______________ State: ________ Zip Code: _________
Home Phone: ___ ___ _____ EMail address:_________________________
Date of Birth: _______________ Age: ____________ __Male __Female
Please Check Membership Type:
1. Individual: Vietnam Veteran (28 February 1961 through 7 May 1975) (In-County)
2. Individual: Vietnam Era Veteran (5 August 1964 through 7 May,1975) (You are eligible for full membership
if you served anywhere in the world)
Attach a Copy of your DD-214 or other official documentation of service in the U.S. Armed Forces
DD-214 Attached: ___ Yes ___ No
Branch of Service: __ USA __ USN __ USMC __ USAF __ UCG
Did you serve in Southeast Asia? __ Yes __ No
__ Associate: Any non-veteran or any Military Service Veteran who did not serve at any time during the Vietnam
Membership dues: Annual Dues __ $20; __3-Year Dues $50; and __Life membership dues based on age.
Ask for specify rates.
In Kansas only we have special rates for First-Time New Members to VVA. Contact me for details. (At this time there
is no special rate break for Associate members.)
It’s not the price you pay to be eligible for membership, BUT THE PRICE YOU PAID TO BECOME ELIGIBLE
Return to your local Chapter or mail to:
VVA Membership, Mel Lucas 915 S willow St Ottawa, KS 66067-3244
Phone: 785-242-8661 email: firstname.lastname@example.org
Please Make Checks/M.O Payable to: Vietnam Veterans of America