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Veterans Caucus membership form

Please fill out and submitt the form below.
A membership fee of $25 per year (June-June) is required. You may pay two different ways:
1. Via postal mail. Mail check to: AAPA Veterans Caucus P O Box 362 Danville, PA 17821
If you choose this option, please make sure to submit form first and with your check, include your information so it can be verified with your online submission.
2. Online. We accept debit and credit cards.

Once the form is submitted, it will redirect to a payment page. If you selected to pay via postal mail, you may disregard the page and continue to surf the Veterans Caucus website. If you selected to pay online, then you may do so. We use YourPay as a means to process our online transactions.

Type of Application	Renewal Initial
Name *
Mailing Address
City
State
Zipcode
Country
Home Phone
Work Phone
Email Address
Membership Status	Veteran (fellow) Active Proof of Service (DD-214 or set of military orders) Non Veteran (Affiliate) Member of AAPA Student (free)
If Veteran - Branch of Service	U.S. Army U.S. Navy U.S. Marine Corps U.S. Coast Guard U.S. Air Force U.S. Public Health Service
If Active	Reserve National Guard Retired None
ID# if Member of AAPA
Choice of Payment	Via Postal Mail Online

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