What Type of Action is this?

                  New Application
                  New Application 3 Years at $99 (paid in advance)
                  Annual/Renewal dues $36 (includes magazines)
                  3 Year Membership $99 (paid in advance)
                  Life Membership Age 80 and older $75
                  Life Membership Age 75 to 79 $100*
                  Life Membership Age 70 to 74 $150*
                  Life Membership Age 65 to 69 $250*
                  Life Membership Age 60 to 64 $350*
                  Life Membership Age 59 and younger $450*
                  1 Year Magazine only subscription $36
                  3 Year Magazine only subscription $99 (paid in advance)
                  Address change
                  Directory corrections
                  Type Directory selection only

*NOTE: Life memberships applies for subscribers as well and may be purchased with three payments
        (includes $5 handling fee per payment).  Contact HQ for details.

            Your Name:  required
        Member Number:  Leave blank if new member
       Street Address: 
       Street Address: 
                 City: 
                State: 
   Zip or postal Code: 
              Country: 
        Email Address:  required
Home Phone:(Area Code) 
Work Phone:(Area Code) 
Fax Number:(Area Code) 
           Occupation: 

I would like to contribute $ to the VHPA Membership Fund.
I would like to contribute $ to the VHPA Scholarship Fund.

Membership Directory Selection:

          No directory (dues includes free access to the online directory)
          Paper directory available in October (extra $10)
          CD-ROM directory available in October (extra $10)
          Both October paper and CD directories ($20 surcharge for both)
         
          Paper directory available now $20 plus $5 shipping and handling
          CD-ROM directory available now $20 plus $5 shipping and handling
          Both paper and CD-ROM directories available now $40 plus $5 shipping and handling
          No current directory (directory is available online free)
         
          Check this box if you do not want your e-mail address in the CD directory
          Check this box if you do not want your phone number in the CD directory

Payment information:

          Information only - no charge
          I will call HQ with my credit card number 800-505-VHPA (8472)
          Please send me a bill to the above address
             (faster if you call in credit card)

Flight school class:  example (67-24/67-503)
        Service branch:  Army, Air Force, Marines, etc.
Social security number: 
   Combat flight hours: 

Information about each Vietnam unit:

         Dates
Unit   From   To       Unit           Location       Call sign
1st:    
2nd:    
3rd:    
4th:    
5th:    
6th:    
7th:    
8th:    

Information about you:

Helicopters flown: 
                   
    Medals/awards: 
                   
          Talents: 
          Hobbies: 
    Anything else: 


For new members only - how did you learn about the Vietnam Helicopter Pilots Association 
and/or why did you join?
     (check all that apply)

     VHFCN or HELIVETS web sites
     VHPA web site
     Referred by  person's name
     Membership gift from 
     Letter received in the mail
     Card received in the mail
     Other - please specify below

Other: