DAV Membership Application

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 71 - 79........................$140 Membership Department

Age 61 - 70........................$180 DAV Bel Air Chapter 30

Age 41 - 60........................$230 P.O. Box 741

Age 40 and under..............$250 Havre de Grace, Maryland 21078

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Last Name First Name Middle Initial

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Spouse’s First Name

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Street Address

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City State Zip

______Male ______Female Birth Date:_____________________

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Date Enlisted Date Discharged

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Branch of Service Rank

Campaign/Expedition Medals Awarded: ___________________________________

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

Disability Discharge? ____Yes ____No

Military Retired? ____Yes ____No

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Date of Application Chapter number and location requested (if known)

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Sponsor’s Name and Code Number if Applicable

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E-mail Address of Applicant

_____ My check is enclosed for: $________

_____Charge my credit card in the amount of: $__________

_____Master Card ____Visa ____American Express ____Discover Card

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Card Number Expiration Date

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Signature Telephone Number