& The Veterans Coalition - Australia
PO Box 183 Nairne
South Australia 5252
Phone : 618-8388-0655 Fax: 618-8388-0606
Website: www.vvnw-au.org/ Email: vvnwnatl@epix.net
"Service Without Reward - Dedication to Brotherhood"
Veterans
of the Vietnam War, Inc.
& The Veterans Coalition - Australia
PO Box 183 Nairne
South Australia 5252
Phone : 618-8388-0655 Fax: 618-8388-0606
Website: www.vvnw-au.org/ Email:
vvnwnatl@epix.net
"Service Without Reward - Dedication to
Brotherhood"
PRINT
MEMBERSHIP APPLICATION
Eligibility: Veterans of all eras and concerned citizens are welcome and
encouraged to join.
_________________________
SERVICE NUMBER
_____________________________
______________________
_____________________
LAST NAME
FIRST NAME
MIDDLE INITIAL
____________________________________________________
STREET
_________________________________
________________________ ___________________
CITY
STATE
POST CODE
_________________________________
__________________ ___________ ________________
AREA CODE - PHONE NUMBER
DATE OF BIRTH MARITAL
NUMBER OF
STATUS DEPENDENTS
POST NUMBER: AU-01, AT LARGE
Member Type: ________________________________
(circle the one
required)
WW1, WW2, Korea, Malaya. Borneo, Vietnam, Vietnam Era,
Peacetime, Gulf, Timor, National Service, Non-veteran
Membership Date: ___________________ Expiration Date: _______________________________
MILITARY INFORMATION:
TO CLAIM
VETERAN STATUS YOU MUST ATTACH COPY OF MILITARY DISCHARGE
Branch of Service: ______________________
Date Entered Service: ___________________________
Type of Discharge: ______________________ Date Discharged:
_______________________________
Service Number: _______________________
I hereby swear to uphold the Constitution and Bylaws of the
Veterans of the Vietnam War, Inc. & The Veterans Coalition
__________________________________
SIGNATURE
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