Application - La Salle VFW Post 4668

VFW MEMBERSHIP APPLICATION

NAME ____________________________________________________________________________________________________________
                          FIRST                                MIDDLE                                                       LAST                                            SUFFIX

ADDRESS _________________________________________________________________________________________________________

_________________________________________________________________________________________________________________
               CITY                                                                                                  STATE                                                           ZIP

EMAIL ___________________________________________________________________________________________________________                                                                        

DATE OF BIRTH _______/_______/__________                                                 GENDER     (  ) MALE      (  ) FEMALE


PHONE  (_________) ___________ - _______________                      SSN  (OPTIONAL) __________ - ______ - ____________


BRANCH OF SERVICE      (  ) ARMY     (  ) NAVY      (  ) AIR FORCE     (  ) MARINES      (  ) COAST GUARD


QUALIFYING CAMPAIGN MEDAL(s) and/or SERVICE _______________________________________________________________________

_________________________________________________________________________________________________________________

DATES OF SERVICE: ________________________________________________________________________________________________

LOCATION OF QUALIFYING FOREIGN SERVICE: __________________________________________________________________________

MEMBERSHIP TYPE (CHOOSE ONE)

ANNUAL MEMBER
Payment Authorization
You may pay by check or credit card. For payments by check you will receive a yearly statement by mail. For credit card payments, please complete the following:

      (  )  I authorize the VFW to automatically charge my account $__________ on a yearly basis to pay my Annual dues.

     (  )  I authorize the VFW to charge my account a one-time payment of $ _____________

LIFE MEMBER
    (  )  I authorize the VFW to charge my account a one-time payment of $ _____________

LIFE MEMBER INSTALLMENT PLAN
    (  )  I authorize the VFW to automatically charge my account $ ___________ to be paid in 11 monthly installment payments after my initial payment of $45.00.

    (  )  I authorize the VFW to charge the $45.00 initial payment and I understand that I will be billed for the remaining 11 monthly installment payments.

VFW MEMBER TRANSFER DECLARATION
(USED FOR Transfers in accordance with Sec. 107 Manual of Procedure)

“I herby certify that it is my desire to transfer my VFW membership from

VFW Post ________________ located in _____________________ to

VFW Post ________________ located in _______________________

I further certify that I am not indebted to my former Post, be it through oral or written commitment or otherwise, and that to the best of my
knowledge no written charges have been preferred against me by my former Post, and I understand that any such indebtedness
or charges which may be disclosed at any time hereafter will render this transfer null and void.”

CERTIFICATION (See Sec. 104 By-Laws)
I attest that I am a citizen or national of the United States, that mu Campaign Service was honorable,
that I have never subsequently been discharged from the military service under dishonorable conditions. I also certify that (1) I am entitled
to a campaign ribbon or medal authorized by the U. S. Government based on my overseas service or; (2) I have served overseas in Korea or; I have received
Imminent Danger or Hostile Fire pay. I further give authority to the Veterans of Foreign Wars to verify honorable overseas service entitling me to membership.

Date: _____/_____/_________


Signature: ________________________________________________________________

Credit Card Info

(  ) MASTERCARD                 (  ) VISA                (  ) DISCOVER                (  ) AMEX

___________________ - __________________ - ____________________ - ____________________
CARD NUMBER
EXP. DATE: _____/_____                  AMOUNT: $_____________

SIGNATURE: _________________________________________________________