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GLBT VETERANS NYC
Membership Application

PLEASE PRINT CLEARLY

Date: Year____ Month____ Day____
Name: surname_______________________________ first name____________________
Address: ____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Telephone _____- ______-________________ e-mail______________________________
Non Veteran ___ Veteran___ Active or Reserve Now____ Disability___________

BRANCH OF SERVICE_______________ SVC DATES: (year)____TO _____
WWII__ Korea__ Vietnam Era__ Persian Gulf__ Afghanistan__ Other____________
Highest Rank________________ Medals, honors, citations______________________

Current or Previous Occupation ____________________________________________

Areas of Interest: Fund Raising__ Newsletter__ Medical Benefits__ Membership__
Public Speaking__ Color Guard/Parade Marching__ Public Relations__ Community__
Other_________________________________________________________________
______________________________________________________________________

Organizational experience:
Secretary______________________________________________________________
Treasurer______________________________________________________________
President/Vice President__________________________________________________
Other_________________________________________________________________

Other skills/experience___________________________________________________
Comments_____________________________________________________________

PRINT FORM, FILL OUT, BRING TO MEETING OR MAIL TO:
GLBT Vets NYC, C/O Queens Pride House, 67-03 Woodside Ave, Woodside NY 11377

Tel: 718 429-5309 Website: www.averny.tripod.com e-mail: glbtvetsnyc@yahoo.com