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for the soft copy form. (MS Word 97 format)
C O N F I D E N T I A L
Counterparts
Tuong Huu Ðông Nam Á
555 W Saddle Dr
Grand Junction, CO USA 81507
Membership Application Form
Category:
Member
- Documented Advisory Service & Foreign Veterans
Associate
- No Advisory Service (Other Veterans, Civilians, Family & Friends)
Affiliate
- Registered Veterans Organizations and Educational Institutions
Publish Data in Member Directory
Do Not Publish Data in Directory
Publish Data On Member Only Web Site
Do Not Publish Data On Web Site
Last Name
First Name
Middle Initial/Sobriquet
Name:
Address:
Street or PO Box
Town/City, State/Province, Country & Postal Code
Telephone:
E-Mail:
Agency or Branch:
(Make sure to use correct capitals/lowercase for AOL addresses)
For. Country:
Duty:
Assignment Specifications
Dates:
Place:
Unit/Agency:
Supervisor:
Counterpart:
Distinctions:
Copies
of documentary evidence of your advisory service and your check for $45.00 USD must be mailed to Counterparts to apply for Plenary Membership and $360.00 for Life Membership.
Other Information & Comments
I, the undersigned applicant, certify that this information is true and correct to the best of my knowledge; and that my service in Southeast Asia was honorable. I authorize the Association to verify my eligibility. I support the principles and camaraderie of the Association.
Application Date:
Signature:
C O N F I D E N T I A L