Vva Election Report Change Of Information Form

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Vietnam Veterans of America
Attn: Membership Affairs
8719 Colesville Road, Suite 100
Silver Spring, MD 20910
Phone: 301-585-4000 - Fax: 301-585-3019
VVA Election Report Change of Information Form
Chapter Number: _________________ State Council: ____________________________ Date: _____________
Chapter Number: ______________ Chapter Name: _________________________________
Contact Person: _________________________________ Title: ________________________
Official Chapter Address: _______________________________________________________
City: ________________________________ State: _________________ Zip: _____________
Chapter Phone: ____________________________
Chapter Fax: ______________________________
E-mail Address: _________________________________________________
Web-Site Address: _______________________________________________
NEW POSTIONS:
President:
Name: _____________________________________ Member No: ____________
Vice President 1:
Name: _____________________________________ Member No: ____________
Vice President 2:
Name: _____________________________________ Member No: ____________
Secretary:
Name: _____________________________________ Member No: ____________
Treasurer:
Name: _____________________________________ Member No: ____________
Secretary/
Name: _____________________________________ Member No: ____________
Treasurer:
Membership
Name: ______________________________________Member No: ____________
Contact:
Revised: 01/27/2012

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