Please print all information plainly

Last Name_________________________First name________________________

Spouse or Other Name_______________________________________________

Name Tags should read:______________________________________________

Home Address______________________________________________________

City_________________________ State_____________ Zip ________________

Phone: Home______________Office _______________ Cell_________________

Date of Birth_____________Marital Status___________ # Children___________

Children's Names___________________________________________________

Service Time? Yes__ No__ Dates____________________Rank______________

VAC Members known to you (if any)___________________________________

Please check areas you are interested in:

Restoration_____Airshows_____Warbirds____Volunteering_____Grants______

Museum_____Advertising____Leadership____Flying, if pilot______Other_____

Comments________________________________________________________

If Warbird Owner Y___ N___ Aircraft___________________________________

INFORMATION IS CONFIDENTIAL - APPLICATION SUBJECT TO APPROVAL BY STAFF

Membership: Single (1) $75.00 Family (2) $100.00 Including children under 18

or Lifetime: $1000.00 Ages 0-59 $750.00 Ages 60-69 $500.00 Ages 70+ Circle One

Check#____________ Credit Card: Please Please circle one: VISA MASTERCARD

_________-_________-_________-_________ Expiration Date:_______________
DONATIONS ARE TAX DEDUCTIBLE

YOU DO NOT HAVE TO BE A WARBIRD OWNER OR PILOT TO BELONG TO THE VALIANT AIR COMMAND