Vinh Long Outlaws Association

Membership Application/Renewal Form

Active membership in the VLOA is open to any person who served with the Outlaws or any affiliated unit at any time between August 1964 and September 1965.  Any person who served with any lineage unit known as the “Outlaws”, or any affiliated unit, at any time after September 1965 is welcomed as an Associate member.  (Please see Article V, Para A&B, VLOA Constitution).

An initial Active or Associate VLOA membership is $20.00, with annual renewal of $20.00 due each January thereafter.  To pay initial membership or renewal dues for this calendar year, please complete and forward this form, with dues payment, to:

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)