MVVV 2010 Membership Form

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MVVV 2010 Membership Renewal Form

Name:___________________________________________________

Address:_{_________________________________________________________}

_{City/Town:
__________________________________Zip____________________}

_Phone:_{(
)}_{__________________}

_{Lifetime Membership Fee: $150}

_{Annual Membership Fee: $25}

_{Donations gladly accepted:
$10_____ $25_____ $50_____
Other______}

_{Make checks payable to: Merrimack Valley Vietnam Veterans, Inc.

P. O. Box 8645

Lowell, MA 01853}