DAV Membership Application
The cost of a life-long membership in the DAV is as follows and may be paid in interest-free installments over three years following a minimum $40.00 down payment:
Age 80 and over ......... Free Age 71 - 79 ..............$140 Mail your membership application to: Age 61 - 70 ............. $180 DAV Department of Virginia Age 41 - 60 ............. $230 P.O. Box 7176 Age 40 and under ........ $250 Roanoke, VA 24019 _________________________________________________________________________ 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 $20.00 down) ____ Life payment Please list your chapter number and location (if known): _______________ 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 If Applicable Telephone Number ____ My check is enclosed or ____ Charge my credit card: ____ Master Card ____VISA ________________________________________________ ___________________ Card Number Expiration Date