Printed Materials Request Form

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Printed Materials Request Form
Vietnam Veterans of America
8719 Colesville Road, Suite 100
Silver Spring, MD 20910
Please send the printed materials indentified below to:
Chapter Number: __________________ State: __________________ E-Mail: ___________________________________________
NAME:____________________________________________________ Title: _____________________________________
ADDRESS: __________________________________________________________________________________________
CITY: ____________________________________________________ STATE:__________________ ZIP:_____________
Home Phone: ____________________________________ Work Phone: _________________________________________
Best time and place to call with questions regarding request: _______________
am
pm
home
work
If rush order, what date is the information needed by?: _______________________________________________________
Is there a special event planned for use of material?
Yes
No
If yes, when, where and how many people are expected?: __________________________________________
________________________________________________________________________________________
Quanity
Printed Materials Requested
VVA Membership Brochure/Applications (Pack of 100)
AVVA Membership Applications
Pocket Membership Applications w/tear-off temporary card/receipt (100/package)
Deceased Member Notification Form
Chapter Charter Petition Package (Request through VVA State Council)
Chapter Election Report form (used to advise National and State Council of April election
results and updates if necessary)
VVA Membership Posters (pack of 10)
Signature: ____________________________________________________ Date: ________________________
Revised: 3/25/2014

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