Application Form

WASHINGTON STATE CHAPTER MEMBERSHIP APPLICATION

Full Name: ____________________________________________

Mailing Address: _______________________________________

Home Phone: __________________________________________

Cell Phone: ____________________________________________

Email Address: ___________________________________

If you do not have an email address, please list email address of relative (for example, son or daughter) or friend who can receive electronic info for you.

Originally from: ________________________________________

Family nickname: _______________________________________

Military Experience

Branch of Service: ______________________________________

Dates of Service: ________________________________________

Would you like to submit a military photo and brief biography of yourself to be posted on the Members Forum section of the NOCVA website? Yes: _______    No: _______

Please submit this completed form and photo and biography if you choose to the following:

As email attachments to: nocva.1@verizon.net

As paper copies to: NOCVA Washington State Chapter

                                      c/o Roberto T. Maanao

                                      3036 Marquette Dr. SE

                                      Olympia, WA 98503-6255

Note: NOCVA Washington State Chapter will not release your personal information to anyone or any group without your knowledge or permission. Information about you, through your membership in NOCVA Washington State Chapter will be limited only to what you submit for publication on our website (such as your biography and photo) or through your participation in a NOCVA sponsored public event (such as a commemoration ceremony). Information submitted on this form will be kept confidential and used for statistical purposes only (for example, number of members living in Washington, Texas, etc) to contact you about NOCVA events, or to send you information of interest as a NOCVA member.