Mid-South Chapter, Vietnam Helicopter Pilots
Association
Membership Application Form
(Must be a current member of the National VHPA
Organization)
Date: _____________ National VHPA Membership No.: ______________
Name: _______________________________________________________
Address: _______________________________________________________
City: ____________________________ ST: ____ ZIP: ______________
Home Phone: ( )_______________ Work Phone: ( )____________
E-mail: ______________________ FAX Number: ( ) _____________
Enclosed is my check / money order for $10.00 payable to Mid-South Chapter, VHPA, good for 12 months' membership, renewable annually during my anniversary month.
Mail application and payment to:
Mid-South Chapter, VHPA
c/o FCC Inc.
5123 Virginia Way, C-13
Brentwood, TN 37027-7519
I would be interested in helping with Chapter activities:
____ Committee Member: _________________________ (area of interest)
____ Member at large, helping to recruit in my area
____ Chapter Officer
____ Chapter Newsletter (writing for it, helping produce it, etc.)
____ Other: _________________________________________________
Mid-South Chapter, VHPA, is a non-profit 501(c)3 Veteran's Organization whose goals and objectives follow those of the National Organization, e.g., fraternal and non-political, as implemented at the local chapter level.
