Category of Membership

New

Renewal

Name *

First Name

Last Name

*Date of Birth

*Only need your birth Month and Day. For Year, just use current year (2024)

MM

DD

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Veteran

Yes

No

Active Duty

Yes

No

Reservist

Yes

No

Family Member of Veteran

Yes

No

If you are a family member of a veteran, please specify:

Spouse

Son/ Daughter

Mother/ Father

Brother/ Sister

Permanent Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

I would like to become a member of HARRY Veterans Community Outreach Services and would like to take advantage of all membership benefits. I am submitting a yearly membership fee of $110. The membership fee is non-refundable and will be used to further our Advocacy, Outreach, delivery of free supportive services and the development/implementation of future programs and/or events. Your membership/dues are a charitable contribution and are tax deductible.

Yes

No

As a member, are you interested in holding a position as:

Officer

Committee Member

Volunteer Office Staff

HARRY Veterans Community Outreach Services members Tee Shirt cost: $15 each, long sleeve shirts are $20, and sweatshirts are $25 each. For sizes 2X and larger there is an additional $5 fee due to purchase cost. Sponsors receive a free tee shirt. Please provide us with your t-shirt size.

Small

Medium

Large

X-Large

2XL

3XL

Today's Date

MM

DD

YYYY