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NASWVC State Coordinator Membership Application

Please email your NASWVC Registration Form to This e-mail address is being protected from spambots. You need JavaScript enabled to view it and mail Associate Dues to Gina Stamper ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ),
at the address below. For Associate Members, please make your check to payable to NASWVC. Membership cards will be electronically mailed
to you upon receipt and verification by the Treasurer.
______________________________________________________________________________________

NATIONAL ASSOCIATION OF STATE WOMEN VETERANS COORDINATORS
New Membership Application and Renewal

Please provide your address information EXACTLY as it must appear on your incoming mail.

Today's Date: ____________

Name:_______________________________________________________________________

First Middle Initial Last

Office Name:____________________________________Position:________________________

Address:_____________________________________________________________________

City:____________________County:__________________State:_____Zip Code:_______+_____

Work Phone:____________________Fax:_________________E-Mail:_______________________

State or Office Website:____________________________________________________________

Military Branch: __________ Dates of Service: ________ to __________

Military Branch: __________ Dates of Service: ________ to __________

Military Branch: __________ Dates of Service: ________ to __________

Please indicate the appropriated category:

New Member: SWVC:__ FVSO SWVC:__

Renewal: SWVC:__ Former SWVC: ___ FVSO SWVC:____

New Associate Member:_______ Renewal: ________

New Vendor: _______ Renewal: ________

State Women Veterans Coordinator Membership (SWVC) – no charge (Current and Past)

State Executive Directors, Commissioners (membership NASDVA) – no charge (Current and Past)

Annual Associate Individual Membership - $10.00

Associate Category: VBA_____ VHA____ Non-Profit____ VCSO___

Private: Business__ Citizen__

VSO: Accredited Veterans Service Organization____ Veterans Organization (Non-Profit)_____

Send checks to:

NASWVC Treasurer, Attn: C/O Gina Stamper
PO Box 5241 Boise, ID 83705-5241

Email Applications to: NASWVC Secretary, Gina Stamper

This e-mail address is being protected from spambots. You need JavaScript enabled to view it (rev. 4/22/13)