gray06 Nov-Dec 2009_Gray01_Jan-Feb 2005.qxd.qxd - Korean War ...
gray06 Nov-Dec 2009_Gray01_Jan-Feb 2005.qxd.qxd - Korean War ...
gray06 Nov-Dec 2009_Gray01_Jan-Feb 2005.qxd.qxd - Korean War ...
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Official Membership Application Form<br />
The <strong>Korean</strong> <strong>War</strong> Veterans Association, Inc.<br />
P. O. Box 407, Charleston, IL 61920-0407 (Telephone: 217-345-4414)<br />
DO NOT WRITE IN THIS SPACE<br />
Assigned Membership Number:__________________________________________<br />
KWVA Regular Annual Dues = $25.00 w Associate Membership = $16.00<br />
MOH, Ex-POW, Gold Star Parent or Spouse & Honorary - $0.00<br />
Regular Life Membership: (May be paid in lump sum or 6 equal payments by check over a 12 month period.)<br />
Ages up to and through 35 years of age:..................$600 Ages 36 through 50 years of age: ....................$450<br />
Ages 51 through 65 years of age: ............................$300 Ages 66 years of age and older: ......................$150<br />
Please Check One: r New Member r Renewal Member (#___________________)<br />
Please Check One r Medal of Honor r Regular Member r Regular Life Member r Associate Member<br />
r Ex-POW r Honorary r Gold Star Parent r Gold Star Spouse<br />
(Please Print)<br />
Last Name ________________________ First Name ______________________ Middle/Maiden Name __________________<br />
Street<br />
________________________________ City ______ State ____________________ Zip______<br />
Phone: (________) ______________________________ Year of Birth: ____________________________________________<br />
Email ________________________________________<br />
Chapter Number/Name (if applicable) #_________<br />
__________________________________________________________<br />
All Regular members please provide the following information if applicable<br />
Unit(s) to which Assigned<br />
Branch of Service<br />
Dates of service:<br />
Division __________________r Army<br />
WithIN Korea were: (See criteria below)<br />
Regiment __________________r Air Force<br />
From ________________ To __________________<br />
Battalion __________________r Navy<br />
WithOUT Korea were: (See criteria below)<br />
Company __________________r Marines<br />
From ________________ To __________________<br />
Other______________________r Coast Guard<br />
“I certify, under penalty of law, that the above information provided by me for the purposes as indicated, is true and correct.”<br />
[If you are applying for membership in a category other than Section 1, par A.1., of the “Criteria for Membership,” complete the<br />
“Certification of Eligibility for KWVA Membership” form on next page.]<br />
Signature: ____________________________________________________________ Date: ____________________________<br />
Make checks payable to: KWVA<br />
Mail to: <strong>Korean</strong> <strong>War</strong> Veterans Association Inc., P. O. Box 407, Charleston, IL 61920-0407 (Telephone: 217-345-4414)<br />
(Or you may pay by Credit Card)<br />
Credit Card # ______________________________________ r VISA<br />
r MASTER CARD (only)<br />
74<br />
Expiration Date ________________________<br />
V-Code ____ Your Signature __________________________________________<br />
Adopted 10/26/<strong>2009</strong><br />
Page 1of 2<br />
<strong>Nov</strong>ember – <strong>Dec</strong>ember <strong>2009</strong><br />
The Graybeards