The cost of a life-long membership in the DAV is as follows and may be paid in interest-free installments following a minimum $40.00 down payment:
DAV
MEMBERSHIP APPLICATION
/ Payment
The cost of a life-long membership in the DAV is as follows and may
be paid in interest-free installments following a minimum $40.00 down payment:
Age 80 and over ......... Free Mail your membership application to:
Age 70 - 79 ............. $140 Membership Department
Age 61 - 70 ............. $180 DAV National Headquarters
Age 41 - 60 ............. $230 P.O. Box 145550
Age 40 and under ........ $250 Cincinnati, OH 45250-5550
_________________________________________________________________________
Last Name First Name Middle Initial
_________________________________________________________________________
Spouse's First Name
_________________________________________________________________________
Street Address
_________________________________________________________________________
City State Zip
____ Male ____ Female
Birth Date: _______________ Social Security Number: ____________________
____________________ ____________________ _____________________________
Date Enlisted Date Discharged Branch of Service
____________________ ____________________
Rank VA Claim Number
__________________________________________ _____________________________
Signature Telephone Number
__________________________________________
Your E-mail Address
Amount Paid:
____ New life membership (Minimum $40.00 down) ____ Life payment
Please list your chapter number and location (if known): Topeka, Chapter #3
I have a service-connected disability rated at ________% (0% - 100%)
Did you receive a Purple Heart? ____ Yes ____ No
Are you an Ex-P.O.W.? ____ Yes ____ No
___________________________________________________ ___________________
Signature Date
____________________________________________
Sponsor's Name and Code Number Telephone Number
____ My check is enclosed or
____ Charge my credit card: ____ Master Card ____VISA
________________________________________________ ___________________
Card Number Expiration Date