Dr. Vincent Quin, Ph.D.
November 15th 09, 02:09 AM
IRAQ VETERANS AGAINST THE WAR
http://ivaw.org
Member Application
Iraq Veterans Against the War (IVAW) is a group of men and women who have served or
continue to serve in the U.S. military since September 11th, 2001. We are calling for:
• Immediate withdrawal of all occupying forces from Iraq; and
• Reparations for the human and structural damages Iraq has suffered; and
• Full benefits, adequate healthcare (including mental health), and other support for
returning servicemen and women.
IVAW welcomes all post-9/11 veterans and active duty servicemen and women from all
branches of military service, National Guard members, and reservists who support this
mission to join our ranks.
Please complete this form (type or print clearly) and submit with proof of service and dues
payment to the address below. IVAW will not share or sell our members’ personal data.
If you would rather apply for membership online, go to http://ivaw.org/member/application)
Name___________________________________ Date ____________________
Address __________________________________ City ____________________
State ____________________ Zip __________
Cell Phone _____________ Home Phone _____________ Email _______________
1.Date of Birth __________ 2. Gender __________ 3. Ethnicity __________
4. Military Occupation _______________ 5. Branch of Service ________________
6. Unit/Major Command _________________ 7. Where Served _______________
8. Current Status: Active Duty ___ Reserve ___ IRR ___ Civilian ___ National Guard ___
Retired ___
9. Date Entered Service __________ ETS/EAS Date __________ End of IRR Obligation
__________
10. Have you been or are you now facing stop loss? __________
11. I am interested in:
___ Organizing members in my local area.
___ Speaking publicly about my experience in and views on the war.
___ Making statements to the press or media about my views on the war.
___ Writing articles about current developments in the war or other relevant topics.
___ Other.
___ No, thank you. I just want to be a member. (turn over)
12. How did you hear about IVAW? ________________________________________
13. Please attach proof of service with at least one of the following:
___ A copy of DD form 214 (if not available please explain)
__________________________________________________ ________________
__________________________________________________ ________________
___ A copy of military photo identification
___ A copy of your Unit Move Order indicating service dates and locations
___ A copy of a medal, award, or certificate of recognition
___ A copy of paperwork from the Veterans Administration
___ Other ____________________
14. T-Shirt Size (circle one) Small | Medium | Large | XLarge | XXLarge
15. Please check appropriate amount for your annual dues:
___ $10.00 Basic Membership
___ $5.00 Student/Low Income Membership
___ $1.00 Active Duty/Unemployed Membership
We welcome donations of additional amounts (circle one):
$20.00 | $35.00 | $50.00 | $100.00 | Other Amount __________
By signing, you agree that you fulfill the membership requirements of IVAW and the
information you provided herein is true and correct.
Signature _________________________________ Date ____________________
Mail your application with proof of service to:
IVAW
PO Box 8296
Philadelphia, PA 19101
----------------------------------------For Office Use Only---------------------------------
Initial and date each area.
Member form rec’d _____ Dues rec’d ______ Dues Entered into DB __________
Added to email list _____ Member Pkt Sent _______ Info sent to RC __________
IVAW??PO Box 8296??Philadelphia PA 19101??Tel: 215 241 7123??Fax: 215 519 4593
--
Each person has an individual responsibility to determine if his actions are moral, and
no government or army may ever take that responsibility away.
definition:
murder - the unjustifiable and intentional killing of people, NO EXCEPTIONS.
http://ivaw.org
Member Application
Iraq Veterans Against the War (IVAW) is a group of men and women who have served or
continue to serve in the U.S. military since September 11th, 2001. We are calling for:
• Immediate withdrawal of all occupying forces from Iraq; and
• Reparations for the human and structural damages Iraq has suffered; and
• Full benefits, adequate healthcare (including mental health), and other support for
returning servicemen and women.
IVAW welcomes all post-9/11 veterans and active duty servicemen and women from all
branches of military service, National Guard members, and reservists who support this
mission to join our ranks.
Please complete this form (type or print clearly) and submit with proof of service and dues
payment to the address below. IVAW will not share or sell our members’ personal data.
If you would rather apply for membership online, go to http://ivaw.org/member/application)
Name___________________________________ Date ____________________
Address __________________________________ City ____________________
State ____________________ Zip __________
Cell Phone _____________ Home Phone _____________ Email _______________
1.Date of Birth __________ 2. Gender __________ 3. Ethnicity __________
4. Military Occupation _______________ 5. Branch of Service ________________
6. Unit/Major Command _________________ 7. Where Served _______________
8. Current Status: Active Duty ___ Reserve ___ IRR ___ Civilian ___ National Guard ___
Retired ___
9. Date Entered Service __________ ETS/EAS Date __________ End of IRR Obligation
__________
10. Have you been or are you now facing stop loss? __________
11. I am interested in:
___ Organizing members in my local area.
___ Speaking publicly about my experience in and views on the war.
___ Making statements to the press or media about my views on the war.
___ Writing articles about current developments in the war or other relevant topics.
___ Other.
___ No, thank you. I just want to be a member. (turn over)
12. How did you hear about IVAW? ________________________________________
13. Please attach proof of service with at least one of the following:
___ A copy of DD form 214 (if not available please explain)
__________________________________________________ ________________
__________________________________________________ ________________
___ A copy of military photo identification
___ A copy of your Unit Move Order indicating service dates and locations
___ A copy of a medal, award, or certificate of recognition
___ A copy of paperwork from the Veterans Administration
___ Other ____________________
14. T-Shirt Size (circle one) Small | Medium | Large | XLarge | XXLarge
15. Please check appropriate amount for your annual dues:
___ $10.00 Basic Membership
___ $5.00 Student/Low Income Membership
___ $1.00 Active Duty/Unemployed Membership
We welcome donations of additional amounts (circle one):
$20.00 | $35.00 | $50.00 | $100.00 | Other Amount __________
By signing, you agree that you fulfill the membership requirements of IVAW and the
information you provided herein is true and correct.
Signature _________________________________ Date ____________________
Mail your application with proof of service to:
IVAW
PO Box 8296
Philadelphia, PA 19101
----------------------------------------For Office Use Only---------------------------------
Initial and date each area.
Member form rec’d _____ Dues rec’d ______ Dues Entered into DB __________
Added to email list _____ Member Pkt Sent _______ Info sent to RC __________
IVAW??PO Box 8296??Philadelphia PA 19101??Tel: 215 241 7123??Fax: 215 519 4593
--
Each person has an individual responsibility to determine if his actions are moral, and
no government or army may ever take that responsibility away.
definition:
murder - the unjustifiable and intentional killing of people, NO EXCEPTIONS.