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 National Headquarters
Age 41 - 60 ............. $230 P.O. Box 145550
Age 40 and under ........ $250 Cincinnati, OH 45250-5550
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Last Name First Name Middle Initial
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Spouse's First Name
_________________________________________________________________________________
Street Address
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City State Zip
_______ Male ________ Female Birth Date: __________________
____________________ _______________________
Date Enlisted Date Discharged
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
______________________________ _____________________________________
Date of Application DAV Dept of NJ LOCATION
_______________________________________________________________________
Sponsor's Name and Code Number if Applicable
_______________________________________________________________________
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
_________________________________________________ ____________________
Card Number Expiration Date
_________________________________________________ ____________________
Signature Telephone Number
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