REGULAR: I'm a veteran of honorable service with the Multinational Peace-keeping forces that served in the operational area of Beirut, Lebanon, during any period since July 1958. I understand that to qualify for regular membership, I must provide evidence of service within 90 days of this application in the form of a copy of my DD214 to include dates of service, unit, and certification of the award of the Armed Forces of Navy-Marine Corps Expeditionary Medal (active duty submit OQR/SRB entries).

ASSOCIATE: I'm not a Beirut veteran, but am or have been an active member of the U.S. military service, support BVA's goals and wish to be enrolled as an associate member. I understand that I must provide a copy of my DD214 within 90 days of this application as evidence of honorable military service.

AFFILIATE: I'm not a Beirut veteran and have never served in the U.S. military, but wish to affiliate with the BVA in order to support the fraternal and patriotic activities of its regular and associate members.

Email Address:

Email must only be in the form username@domain.type    Example: smith@aol.com
Otherwise, you will not get a confirmation email of your submission.

Full Name:

Address (line 1):
Address (line 2):

City:		State:
Zip Code:		Country:
Phone:		Fax:

Unit/Ship:

Date(s) Served in Beirut:

From:

To:

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DUES: The Board of Directors has determined that dues will be $15 per year.

Life memberships are available; Under age 56, dues are $150; over
age 56, dues are $100. Donations are accepted to defray postage,
printing and other operational and organizational expenses.

A donation is not required in order to apply for membership.

I've enclosed my $15 dues for 1999-2000.
Sign me up as a Life Member under age 56 ($150)
Sign me up as a Life Member over age 56 ($100)
I'm the immediate NOK of a servicemember killed in Beirut,
sign me up as an Honorary Life Member (NOK-no dues)

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DONATIONS: Donations may be made to the BVA, registered in the State of Virginia as a not for profit veterans service organization. PLEASE ACCEPT THE ENCLOSED DONATION IN SUPPORT OF BVA'S ORGANIZATIONAL AND OPERATIONAL SERVICES:

$ ______________

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Would like to be on our mailing list? Yes (Leave this checked if you do)

(NOTE: This item refers to regular US Postal Mailings i.e. Root Scoop II, etc.)

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Would like to be on our e-mailing list? Yes (Leave this checked if you do)

(NOTE: This item refers to periodic e-mails of items of interest and you will be able to unsubscribe at any time, as the information will be included in each email.

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BVA SERVICE:

I'm interested in serving BVA as a:

Board Member
Officer
Committee Member
Other _________________________________

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COMMENTS: (70 maximum characters, there is more allowance for comments in the database contacts section and we encourage you to sign up there and post an entry.)

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