EmailMe Form - MVC Membership Registration

Date Time

MM / DD / YYYY

Name *

First Last

Spouse Name

First Last

FMCA Number *

Form Submission number

Referred by:

First Last

The Membership year is Jan.1st to Dec.31st. Dues paid after Sept. 30 shall cover the following
year.

If your dues are 90+ days in arrears, you have been removed from the Membership List. We need your info!!!

WE DO NOT PRO-RATE DUES.

Dues is as follows:
2 year = $20
3 year = $30
5 year = $50

We can only keep one address on file at a time. If necessary, please send us a permanent change of address. *

I understand.

Please select one.

New Member

Renewing Member

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Primary Phone

### - ### - ####

Alternate Phone

### - ### - ####

Email *

Confirm Email

Your Branch of Service *

Spouse's Branch of Service (If any)

I certify by clicking the agreement below that I am on Active Duty with, or was Honorably Discharged from the United States or Canadian Armed Forces or National Guard. *

I agree

I understand that I will not be a member until the Treasure receives my dues payment. *

I am sending dues payment via PayPal.

I am sending dues payment via US Mail.

Please mail your cash, check or money order to:
Military Veterans Chapter, PMB 1550
3916 N Potsdam Ave
Sioux Falls, SD 57104

Please make payable to:
Military Veterans Chapter - FMCA
PLEASE be sure to include your FMCA # on the bottom of your check. *

I understand my membership is not complete until Tom receives my payment.

Your comments (50 space limit).