Member Form

Full Name*

If you are registering for membership on behalf of a business or organization, you will have the option to enter the organization's information below and appoint a main point of contact for the membership.

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone (Home)

Phone (Cell)

Email*

Enter Email Confirm Email

Service Status*

Active Duty
Reservist
Retired Veteran

Branch of Service*

Are you registering as a business, organization, or for a friend?

Yes
No

Name of business or organization

Information in this section will be used for official membership information.

Business Membership Point of Contact for Company or Individual

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone

Business Email

Enter Email Confirm Email

Select Your Membership Type

Select from one of the membership types below.

Membership Choices*

If giving as a gift, enter the person or organization's information below your information in the form. If selecting a payment plan option, you will be charged for the amount listed above. Associate memberships are for non active duty and non veteran women, and for men who want to support WVI.

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