Howard County Vietnam Veterans Organization
HCVVO MEMBERSHIP FORM
**Please note that if your are a veteran, you must supply a copy of your DD-214 form or other proof of military service with this application for membership, unless you have submitted a copy previously.** A lifetime membership cost $100.00. A yearly membership cost $20.00 per year. You can have a yearly membership and convert it over to a lifetime membership for $100.00 anytime you wish.
Name: ____________________________________________ Date: ___________
Address: __________________________________________ City: ____________
State: ______ Zip Code: ________________ Email: ______________________
Phone: ____________ Cell Ph: ______________ Date of Birth:____________
Branch of Service: ____________ Unit Served With: ___________________
# of years in Service: _________ Yrs. Of Service _________________
Type of Membership: Annual Lifetime New Renewal
Vietnam Veteran: ______ If in- country, served in: __________________________
Please check all that apply to your service and/or application:
_____ Korea ____Panama ____Grenada ____Bosnia____Kosovo ____ Gulf War
____Desert Storm _____ Afghanistan ____ Enduring Freedom ____ Iraq ____ Cold War
____ Peacetime ____ Assoc ____ Other
Membership application taken by: ____________________________________________________
OFFICIAL USE ONLY
Date paid: _________-- Paid by: Cash _______Check __________M.O #_____________________
Payment received by: _________________________________________________
Membership paid by: __________________________________________________
Date of Renewal if annual __________ Amount paid: ________________________
8313 East 400 South Greentown Indiana 46936, phone 765 628 0297, fax 765 628 3068. Email vveterans@aol.com
