Membership

Prefix    First Name    MI    Last Name
Address 1    Address 2
City    State     Zip    Country
Email    Cell
Home Tel    Work Tel    Fax
Date of Birth    Age    Male   Female
Present Status  Active Duty  Reservist  Veteran (served 180 days with honorable discharge)
   National Guard  Retired  Non-Veteran (non-veterans are Associate Members)
Social Security    Branch of Service    Service Dates   to  
 Membership renewal    New member   NABVETS Chapter (if applicable)
Referred by  Eclipse Magazine  Website  Community Event
   Veterans Administration  Friend  Other
Currently Employed?    Yes    No   Occupation    Company
Retired?    Yes    No   Other memberships (optional)
Race/Ethnicity  African American  Asian  Caucasian  Hispanic
(optional)  Native American  Pacific Islander  Latino  Other
   Alaskan Native  Native Hawaiian    
Membership Type
All memberships include a subscription to the Eclipse
Magazine, for the length of the membership
 $40 Annual Membership
 $70 Two year Membership
 $80 Three year Membership
 $250 Silver Life Membership
 $500 Gold Life Membership
 $1,000 Diamond Life Membership
 Chapter dues (if applicable)  $
 Additional tax-deductible contribution of   $
• If you would like to Pay Online using either your
credit card or PayPal
check here and you will pay online on the next screen.
• If you would rather we call you to get your credit card information
check here and we will have someone from
our staff call you for that information.
• If you are paying by check or money order
check here and make it payable to NABVETS and mail to:

National Association for Black Veterans
5515 Steilacoom Blvd. #110
Attn: Membership Department # S-112
Lakewood, WA 98499

Thank you!
I hereby attest that I will abide by the principles and policies of the National Association for Black Veterans, Inc., and to the
utmost of my abilities, assist in the promotion of positive lifestyles for veterans, their families and the entire community, with a
special emphasis on the unmet needs of minority veterans, homeless veterans and youth development.