Membership Application/Update Form (Non-Veterans Only)

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Name (Required Field): *

Email address (Required Field): *

Cell Telephone (Required Field): *

Birth Day (Month/Day) (Required Field) *

Are you attending spousal or couples counseling at a VA Vet Center? (Required Field)

Yes
No

*

Has your veteran applied for VA benefits? (Required Field)

Yes
No

If no, do you require help locating a Veterans Service Organization (VSO) or Veterans Service Group (VSG) representative to assist you? (Required Field)

Yes
No

Are you a member of Linked Up Church? (Required Field)

Yes
No

Release of Information: “I consent to the release of my cell phone number and email address to other members of the “Vets in the Know” Connect Group.” (Required Field)

Yes
No

Signature and Date (Type): *

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Membership Application/Update

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