|
Vinh Long Outlaws Association
Membership Application/Renewal Form
Active membership in the VLOA is open to any person of any rank who served with the any lineage unit known as the "Outlaws" (and "Mavericks" armed Platoon) or any affiliated unit between August 1964 and the present. These units include the 6nd Aviation Company, A Company 502nd Aviation Battalion, 175th Assault Helicopter Company, B Troop 1-158th Aviation Regiment (Iraq), 150th Transportation Detachment "Roadrunners", 28th Signal Detachment (Viet Nam), and 25th Infantry Division "doorgunners" (Viet Nam).
An initial Active VLOA membership is $20.00, with annual renewal of $20.00 due each January thereafter. A lifetime Membership is $100.00, with no annual renewal requested. To pay initial membership or renewal dues for this calendar year, please complete and forward this form, with dues payment, to: VLOA: c/o:
Charles Bouton, 2013 SW Providence PL. Port St. Lucie, FL 32446
First Name __________________ MI ___ Nickname _____________ Last Name _____________________
Address________________________ City ___________________ State________ Zip __________
Telephone # (Home) _____________ (Work) _____________ Spouse's Name ______________________
E-Mail address __________________________________________________________________________
Dates assigned to Outlaws/Attachments (Mo/Yr/to Mo/Yr) ______________ to _____________________
Unit/plt/sect/posn ____________________________ Radio Call sign ______________________________
Please initiate ___ or renew ___ my Active VLOA membership. Make check payable to VLOA.
Please initiate ___ or renew ___ my Associate VLOA membership. Make check payable to VLOA.
Please ___ do not renew my VLOA membership, but please keep my name on the VLOA roster.
I understand that I may not receive any future issues of the VLOA Newsletter.
I know of a former Outlaw/Maverick/Roadrunner or other affiliated unit member and have indicated his name, address, and phone number below.
Comments: _____________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Click here to download a printable version of this form (requires free Adobe Reader download)
|