KHE SANH VETERANS ASSOCIATION Inc. Membership Application

Please Copy and print this form, Fill form and submit with your dues payment to:

Khe Sanh Veterans Inc.
c/o Vince Griffith
27280 Jefferson St. Suite 200
Temecula, CA 92590
909 676-6047

Last Name:...........................................................................

First Name:...........................................................................

MI:..............

Nickname:.......................................................................

Address:............................................................................

City:....................................................................................

State:.........................................

Zip + 4:......................................

Home Phone:.............................................

Work Phone:.........................................

Email Address:......................................................................

Are You A

Khe Sanh Vet:

circle one:..............YES..........NO

If YES when were

you at Khe Sanh:...................................................

If NO what is your Association

with the Khe Sanh Vets:...................................................

Service Branch... AIR FORCE...ARMY... NAVY... USMC... CIVILIAN

Your Unit:...................................................

Membership Type:

circle one................. Life $150..... Regular $ 20..... Associate $ 20

Unable to join at present list my name in the

Membership Directory circle one:.........................YES.....NO