| Name:________________________________ |
MEMBERSHIP TYPES |
|
Address:_____________________________ |
One Year @ $20 Annual Three Years @ $50 |
|
City: ________________________________ |
Life Memberships (Select Age Group) |
|
State: _______________ Zip: _____________ |
Age 49-under @ $250 ____ Age 50-55 @ $225 ____ |
|
Phone: ______________________ |
Age 56-60 @ $200 _____
Age 61-65 @ $175 ____ |
|
E-mail: ________________________________ |
Age 65-over @ $150 ____
Life Payment Plan: $50 Down |
| |
(8 monthly payments of $25) _____ |
|
PAYMENT METHOD |
|
| Check_____ Money Order_____
Credit Card: ____ Visa; Mastercard; Discover;
or American Express |
Credit Card No._________________________
Expiration Date: Mo._____ Yr.______
Signature_______________________________ |
|
___ Check here if you are eligible to be or are a
member of Vietnam Veteran of America.
|
PLEASE MAIL WITH YOUR PAYMENT To:
AVVA Chapter 284 Membership
c/o Penny Meinhardt
P.O. Box 610906
Port Huron, MI 48060 |
