EVERY YEAR EVERY CHAPTER WISHING TO RENEW AS A CHAPTER OF MODERN DAY VETERANS MUST

DIRECTOR INFORMATION

 

NAME first __________________last______________________________________birthday  Month--------- day ___________     year____

SPOUSE’S NAME___________________________ _birthday m____ d______year---------------

ADDRESS__________________________________________________________________________

OCCUPATION _____________________________________________________________________

CHILDREN’S NAMES AND birthday_________________________________________________

_____________________________________________---------------------------------------------------------

ss number or drivers license number_____________________________

TELEPHONE_____________________-FAX_______________________E MAIL;_______________

DATES AND TIME YOU CAN WORK WITH NATIONAL                                                                                                                                    

BEST TIME TO CONTACT YOU