Vietnam Helicopter Pilots Association of Florida

c Application          c Renewal           c Address Change

Name                                                                                                                      

Address                                                                                                                  

City                                                                       State                Zip                    

Effective Date                                                   E-Mail                                             

Phone                                              (H)                                                             (W)

Branch of Service                                            Flight Class                                     

Vietnam Tour(s)—Mandatory for initial applications

From                     To                        Unit

Please attach any additional information you wish to submit, i.e. call signs, awards, type of aircraft flown, etc.

c 1 Year-$15                           c 3 Years-$40                        c Lifetime-$150

Make check payable to:            VHPA of Florida, Inc.

          Mail form and check to:           VHPA of Florida, Inc

                                                         3602 N US Highway 301

                                                         Tampa, FL  33619-1247