Application / Roster form

       Last Man Club of  Vietnam War Era

                         of Saint Peter


                                                    Member #__________  










E-mail address_____________________________________


Home phone:______________Mobile phone:_____________


Branch of Military__________________________  Purple Heart    (   )


Date entered Service________________________________

Date discharged from Active Duty______________________


(to be completed at the appropriate time)

Date of death:_____________________________________


Please include a copy of your DD214


Life Time membership Dues:  $20.00

      (checks  made out to:  Last Man Club of Vietnam War Era)                    



                Proud to be a Veteran