Name: ___________________________      Date Of Birth: ___________             Sex: M/F 

Address: _________________________          Home Phone:  (___)_______________

City: ___________________ State: ___      Work Phone:  (___)_______________

Zip Code: __________ Country: ______            Email: ______________________ W/H

Eligibility: Vietnam and Vietnam-era veterans who served on active duty in the U.S. military between February 28, 1961 and May 7, 1975 (In Country Vietnam Vets), or Between August 5, 1964 and May 7, 1975, for Vietnam-era Veterans. 

___ 1 year - $20.00 ___ 3 years - $50.00  Life Memberships from $150 to $250.

Payment Option

 ___ Check            ___ Money Order             ___ Credit Card (Visa, MC, Amex) 

Credit Card #_______________________ Exp. Date ___/___ 

Signature: ____________________________ Date: ______________

Meetings are held on the Second Tuesday of each month at 7:00 p.m. at the Veterans Memorial Bldg. 1100 Main Street, Ferndale, CA. 

We look forward to meeting you at our meeting. 

Please mail your completed Membership Application to: 

Vietnam Veterans Of America
Chapter 781
P.O. Box 102
Ferndale, CA 95537-0102

info@vva781.org

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