ENROLLMENTS

APPLICATION FOR MEMBERSHIP
RENEWAL OF MEMBERSHIP
Please fill in all areas that are applicable to you. This will enable us to to update our records.
SURNAME		FIRST NAME
STREET ADDRESS
SUBURB		POSTCODE
EMAIL		NAME OF SPOUSE
TELEPHONE		MOBILE
SERVICE	Navy Army RAAF Qantas Other	DETAILS OF OTHER SERVICE
DISCHARGE RANK		DISCHARGE DATE
OFFICIAL No.		BRANCH
SHIPS/UNITS SERVED
HONOURS/MEDALS HELD	AASM ASM SVCM VLSM Other	DETAILS OF OTHER AWARDS
RAS BADGE No.		WORK DETAILS	Employed Retired
Were you referred by a member of the VLSVA?		yes no
If yes, by whom were you referred?
Please submit your application/renewal by clicking on the submit button below. An account will be sent to you by mail within the next couple of days. Or alternately print this page and send with Cheque/Money Order to the Treasurer, VLSVA (Inc) of WA., 2 Chivrell Rise, Gwelup. WA. 6018. Cheques are to be clearly marked VLSVA.
Annual Membership $30.00			2 Year Membership $50.00
	Gold Card Membership (5 years) $120.00

For More Information Contact:

The Treasurer

Vietnam Logistic Support Veterans Association (VLSVA) Inc of Western Australia

PO Box 1588,

Subiaco, WA. 6904

Contact: Chris Nicolaides OAM

Phone: 08 9448 3860

Send email to Colin Trickett with questions or comments about this web site.
Copyright © 2003 VIETNAM LOGISTIC SUPPORT VETERANS ASSOCIATION (VLSVA) Inc. Of WESTERN AUSTRALIA
Last modified: September 08, 2003