Michigan Association of County Veterans Counselors Membership Application

Name:__________________________________                    County:_____________________________

Title:___________________________________                     Date:______________________________

Office Address:___________________________                    Telephone:__________________________

Fax:___________________________________                      E-mail address:______________________

Office Hours/Days of Operation:______________________________________________________

------------------------------------    OTHER OPTIONAL INFORMATION     ---------------------------------------

Public law under which your office operates:

P.A. 77_____              P.A. 139_____            P.A. 192_____            P.A. 214_____

Other (please specify)________________________________________________

Military Service (if any)Branch:_____________  Entry Date:_______________ Discharge Date______________

ANNUAL DUES ARE $25.00 FOR MACVC AND $30.00 FOR NATIONAL ASSOCIATION OF COUNTY VETERANS SERVICE OFFICERS ($55.00 TOTAL).                                                                                                                       

Print and mail to:

Tina Roff, Treasurer
171 Dawson St.
Sandusky, MI 48471

Updated January 2003