DAV Application Form
Membership Application
Secure Connection
Questions • Verify • Receipt
1. Your Age

1. Your Age

For Life Membership calculations: 40 or younger = 250.00; 41 thru 60 =230.00; 61 thru 70 =180.00; 71 thru 79 = 140.00; Over 80 = FREE. Otherwise, yearly membership is 40.00 upon application submission.
2. Title

2. Title

Mr. Mrs. Ms. Miss. Dr.
3. First Name

3. First Name
4. Middle Initial

4. Middle Initial
5. Last Name

5. Last Name
6. Suffix

6. Suffix

Sr. Jr. II, III, IV, V.
7. Address:

7. Address:
8. Address2:

8. Address2:
9. City/ Town

9. City/ Town
10. State/ Province

10. State/ Province
11. Zip Code

11. Zip Code
12. Cell Phone

12. Cell Phone
13. Home Phone

13. Home Phone
14. Email Address

14. Email Address
15. Gender

15. Gender

16. Date of Birth

16. Date of Birth

MM/DD/YYYY
17. Spouse's First Name

17. Spouse's First Name

If applicable
18. Sponsor/ Referral Name

18. Sponsor/ Referral Name
19. Service Branch

19. Service Branch

Army, Navy, Marine Corps, Air Force, Army Air Corps, Coast Guard, Federal Agency, Merchant Marine, Women Air Corps, Army National Guard.
20. Date Enlisted

20. Date Enlisted

MM/DD/YYYY
21. Date Discharged

21. Date Discharged

MM/DD/YYYY
22. Rank

22. Rank

E-1 thru 9; O-1 thru 10; WO- 1 thru 5 etc.
23. Membership Eligility

23. Membership Eligility

Please define your Membership Eligibility by checking all that apply.

24. % Of Eligibility

24. % Of Eligibility
25. Chapter Preference

25. Chapter Preference

Example: Pahrump #15
26. Department

26. Department

DAV Sponsor Information; this section is only to be completed by DAV Sponsor.
27. Sponsor Name

27. Sponsor Name
28. Sponsor Membership Code

28. Sponsor Membership Code
29. Electronic Signature

29. Electronic Signature

Just type in your name.
30. Todays Date

30. Todays Date

MM/DD/YYYY
31. Verifier

31. Verifier

For security purposes, we ask that you enter the security code that is shown in the graphic. Please enter the code exactly as it is shown in the graphic.
Your Code
Enter Code
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