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AVVA Membership Application

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AVVA Membership Application

This membership form may be completed and submitted online. Please mail your payment for the AVVA membership to:

Vietnam Veteran's of America
Chapter #20
P.O. Box 12580
Rochester, NY 14612

 

AVVA Membership Application (bold fields are required.)
First Name
Last Name
Address

City, State, Zip Code
   
Home Phone, Ext.
   Phone: (NNN) NNN-NNNN  Ext: NNNN 
Work Phone, Ext.
   Phone: (NNN) NNN-NNNN  Ext: NNNN 
Primary Email
Date of Birth
Date: MM/DD/YYYY 
Term
 Annual Membership : 1 year $20.00
 3-Year Membership : $50.00
 Lifetime Membership :

$200.00 56yrs - 60yrs
$175.00 61yrs - 65yrs
$150.00 66yrs - 71yrs
$100.00 72yrs +

 

 

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