VIETNAM VETERANS OF AMERICA CHAPTER 634 P.O. BOX 954 JACKSON, OHIO 45640 1-740-777-1525 EMAIL: JDDAVIS_71@YAHOO.COM
Special
Notice If you are a veteran in emotional crisis and need help RIGHT
NOW, call this toll-free number 1-800-273-8255, available 24/7, and tell them you are a veteran. All calls are confidential.
CONTACT NUMBERS
VIETNAM VETERANS OF AMERICA CHAPTER 634 JACKSON, OHIO 1-740-777-1525
Membership is open to U.S. armed forces
veterans who served on active duty (for other than training purposes) in the
Republic of Vietnam between February 28, 1961 and May 7, 1975, or in any
duty location between August 5, 1964 and May 7, 1975.
ATTENTION: New
members and new life members
You must submit a copy of your DD Form - 214 form
along with this
application and dues payment.
Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
E-Mail Address:
Date of Birth:
Sex:
Optional:
Chapter No.
Sponsor:
___I am
already a VVA member and want to become a life member.
My VVA Member number is ______________ .
Type of Membership:
Life
Member-Ages 49 and Under : $250
Individual Member -1 year: $20
Life
Member-Ages 50-55: $225
Individual Member-
3 years: $50
Life
Member-Ages 56-60: $200
Life
Member-Ages 61-65: $175
Life Member-Ages 66+: $150
Optional Time Payment plan-
$50 down, $25/month
Payment Method:
Check
Money
Order
Credit Card (Visa,
Mastercard, American Express, Discover)
Credit Card Number:
Exp. Date:
Signature:
Return your completed
application, payment, and a copy of your DD Form-214 to:
Print
Application
