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VCR MEMBERSHIP APPLICATION FORM
PRIVATE AND CONFIDENTIAL

Membership in the organization is limited to [a] those individuals who are honorably discharged or retired veterans of the Armed Forces of the United States (b) current active duty members of the Armed Forces of the United States, or (c) the spouse, widow or widower of either (a) or (b). If you have any questions about your eligibility, please don't hesitate to e-mail, write or call us. You will be required to provide proof of service or marriage to a veteran or active duty service member.

Only honorably discharged or retired veterans shall be eligible to vote or hold a seat on the Board of Directors, in accordance with the Bylaws of the organization

AFTER YOU PRINT THIS QUESTIONNAIRE, PLEASE PRINT OR TYPE CLEARLY AND MAIL WITH YOUR FEE TO: Veterans for Constitutional Restoration (VCR) Inc.
1976 Havasu Garden Drive, Lake Havasu City, AZ 86404
Those items marked with an * are required items:

*Today's Date_________________ SSN_________________________
(Federal law requires that we ask for your SSN. You are not required to provide it)

*Name_______________________________________________________________

*Mailing Address______________________________________________________

*City _________________________ *State ______ *zip code____________________

*Telephone number _________________________Fax number ________________________

*e-mail address__________________________

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For veterans or active duty members:
*Branch of Service _________________ *rank/rate/grade: ____________________

*Are you (check whichever applies):
____ an honorably discharged or retired veteran?
____ Currently on Active Duty with the Military Forces of the United States?
____ The Spouse, widow or widower of a veteran or active duty member of the Armed Forces of the United States?

*Proof of service (if veteran or active duty service member): 

___ copy of DD214 ____ copy of ID card ____ copy of Discharge/Retirement Certificate
___ Other (please explain - must be accepted by the Board of Directors on a case basis) ___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

*Proof of Marriage to veteran or active duty member (if spouse, widow or widower):
____ copy of marriage certificate (Additionally, please submit proof of your spouse's military service with the copy of your marriage certificate)

Individual Fees	Yearly Fee		Lifetime Fee
___ Voting Associate	$25.00	___ Voting Life Associate	$250.00
___ Nonvoting Associate	$15.00	___ Nonvoting Life Associate*	$150.00

*Nonvoting Life Associate open only to the spouse, widow or widower of a veteran or active duty, national guard or reserve member of the Armed Forces of the United States.

___ In addition to my membership fees, I am also enclosing the following contribution_________

___ I do not wish to join at this time, but I am enclosing the following contribution____________

 SIGNATURE REQUIRED TO PROCESS APPLICATION

By signing this document I hereby acknowledge that I support the Constitution of the United States of America as the supreme law of the land and believe that the country needs to return to the republican form of government this nation was founded upon, as defined in the Constitution of the United States.  I also acknowledge that fees and contributions are not tax deductable as charitable contributions under IRS rules and regulations.

SIGNATURE _____________________________________date_______________________________

* We accept checks and money orders (US currency only), Visa, Mastercard and American Express*

*Checks and money orders should be payable to:
Veterans for Constitutional Restoration and mailed to:
1976 Havasu Garden Drive, Lake Havasu City, AZ 86404

*I am enclosing: ___ check ___money order

*Or click this link to join with your credit card online using PAYPAL SECURE SERVER (Don't forget to mail in this form with your DD214).

Database entry_________ date_____________ by______________