VVA Member EZ Renewal Form (For VVA Members who failed to receive or lost their membership renewal)

Submit to:

Vietnam Veterans of America P.O. Box 64299 Baltimore, MD 21264-4299 Chapter Number (if applicable): ______________

Date: ____________________

VVA Membership Number: __________________ Name: _______________________________________________________________________________ Address: _____________________________________________________________________________ City: ____________________________________ State: ___________________ Zip: ________________ Phone: (H) _________________________________ (W) ______________________________________ E-mail Address: ________________________________________________________________________ Type of Membership Renewal 1-Year Individual IND $20

3-Year Individual IND $50

(If applying for new life membership or a new life membership payment plan, you MUST submit a copy of your DD-214 along with this form)

Life Member (age 56-60) $200

(age 61-65) $175

Payment Method (do not send cash) Check

(age 66-71) $150

(age 72+)

$100

Total Amount Paid: $______________ Money Order (Make checks and money orders payable to ‘VVA’)

Credit Card (VISA, MasterCard, American Express or Discovery)

Credit Card Number: _________________________________ Exp. Date: ______________ Signature: __________________________________________ Revised 10/2012

VVA Member EZ Renewal Form - Chapter 522

Zip: Phone: (H). (W). E-mail Address: Type of Membership Renewal. 1-Year Individual IND $20. 3-Year Individual IND $50. (If applying for new life membership ...

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