DAV Membership Application

The cost of a life-long membership in the DAV is as follows and may be paid in interest-free installments over three years following a minimum $40.00 down payment:

Age 80 and over ......... Free
Age 71 - 79 ..............$140           Mail your membership application to:
Age 61 - 70 ............. $180            DAV Disabled American Veterans
Age 41 - 60 ............. $230            P. O. Box 145550
Age 40 and under ........ $250            Cincinnati, OH  45250-5550 

_________________________________________________________________________
Last Name                     First Name                   Middle Initial
_________________________________________________________________________
Spouseís First Name
_________________________________________________________________________
Street Address
_________________________________________________________________________
City                          State                        Zip
____ Male   ____ Female

Birth Date: _______________  Social Security Number: ____________________
____________________  ____________________  _____________________________
Date Enlisted         Date Discharged       Branch of Service       
____________________  ____________________
Rank                  VA Claim Number
__________________________________________  _____________________________
Signature                                   Telephone Number
__________________________________________
Your E-mail Address

Amount Paid:
____ New life membership (Minimum $40.00 down)     ____ Life payment

Please list your chapter number and location (if known):  _______________

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
___________________________________________________   ___________________
Signature                                             Date
___________________________________________________   ___________________
Sponsorís Name and Code Number If Applicable          Telephone Number
____ My check is enclosed or
____ Charge my credit card:  ____ Master Card    ____VISA
________________________________________________      ___________________
Card Number                                           Expiration Date