Date: ______________________________

Name: _______________________________ Spouse: _________________________

Address: _____________________________ Phone: _________________________

_____________________________ E-mail __________________________

Children (living at home): __________________________________________________

Birthdays (Month & Day): Member: ______________ Spouse: __________________

Children’s Birthdays: _____________________________________________________

List Military Vehicles: ____________________________________________________

_______________________________________________________________________

(It is not necessary to own a military vehicle to become a member)

If a member of the National MVPA, list your number: ___________

ANNUAL DUES:

Member or member and spouse: $15.00 _________

Associate member: (business/club) $25.00 _________ (Send a business card so we can advertise your business or club in the quarterly newsletter)

All members receive a quarterly newsletter and can place free classified ads in the newsletter and on the web page. www.arkansasmvpa.com

Mail a copy of this form and dues, payable to AR MVPA, to:

Evelyn Harless, Secretary

1279 Ada Valley Rd.

Adona, AR 72001

For additional information contact Paul Harless at plheh@cyberback.com

*Arkansas MVPA encourages all members to join the National MVPA