Veterans voting Line
PO Box 17612
Fort Worth, TX 76102-0612
Please print, fill in form, and mail to above address
along with your check for Membership Dues
Type Membership Requested: REGULAR Associate
Last Name: __________________ DOB: _______________________
First Name: __________________ SocSecNr: __________________
Middle Initial: ________________
Address: _____________________________________________________
_____________________________________________________
City: _____________________________________________________
State: ____________ ZIP Code: _____________
Home Phone: (_______) ______________________
Work Phone: (_______) ______________________
FAX Number: (_______) ______________________
E-mail address: _____________________________________________________
Occupation: _____________________________________
Branch of Service (for military member): ____________________________
Dates Served in Military: From: ___________ to: _________________
Military Service Number (If different from Soc. Sec. Nr) _______________
Marital Status: Single Married Divorced Widow/Widower
Spouse Name: ___________________________ DOB: ______________
