VAVS Update Form
Fill out the form below or email completed form to AGSMVAVS@AmericanGoldStarMothers.org
Member Name
First Name
Last Name
Associate Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Status (Mark all that apply)
Chapter Appointed Officer VAVS Chair
Certified VAVS Representative
Department Appointed VAVS Chair
Certified VAVS Deputy
Chapter Name
Department Name
Location of VA Volunteer Service Facility:
Name of Facility:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Regular Volunteer:
Yes
No
Occasional Volunteer:
Yes
No
Donate to AGSM:
Yes
No
If donating your hours to AGSM, please indicate the number of hours you are donating.
Signature
Continue
Continue
Should be Empty: