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WE WANT YOU Dedicated to supporting veterans SPECIAL DISCOUNT* LIFE TIME MEMBERSHIP $100 Limited Time Only Until 12/31/2015 Name: ______________________________________________ Male Female DOB: ________________________ Address: ____________________________________________ City: _______________________ State: ___ Zip:___________ Telephone:___________________________________________ E-Mail: _____________________________________________ Chapter #126 ________________________________________ Sponsor: (optional) _____________________________________ Type of Membership: $20 (1 Year) $50 (3 Years) Life Member (after 12/31/15) $200 (age 56-60) $175 (age 61-65) * Life Member (before 12/31/15) $150 (age 66-71) $100 (all ages) $100 (age 72+) Payment Method: Credit Card: Visa Check Money Order MasterCard AMEX Discover Credit Card Number: Signature: __________________________ Exp. Date: ________ ELIGIBILITY. Membership is open to U.S armed forces veterans who served on active duty (for other than training purposes) in the Republic of Vietnam between February 28, 1961, and May 7, 1975, or in any duty location between August 5, 1964, and May 7, 1975. Return to: Vietnam Veterans of America, VVA #126 One Center Street, 22nd floor, New York, NY 10007 Membership questions: Fred Gasior 516-769-6847 You must submit with membership application, payment, and a copy of your DD214. Support those who support our Nation’s injured service members, veterans and their families. Dozens of NYC restaurants have donated to the Bob Woodruff Foundation to take part in the 2nd annual DINE OUT FOR HEROES NOVEMBER 9-13 The Bob Woodruff Foundation creates long-lasting, positive outcomes for our nation’s wounded, ill and injured veterans, service members and their families, by finding, funding and shaping initiatives that enrich the lives of these heroes. No purchase necessary. Participating restaurants are listed at BobWoodruffFoundation.org #Dine4Heroes NOVEMBER 11, 2015 43