WOMEN VETERANS OF NEW MEXICO APPLICATION FORM
Please provide the following information by typing or choosing the best answer:
Email address *
Today's Date *
MM
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DD
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YYYY
New Member or Renewal? (If you are renewing your membership, only enter the information that has changed, for the remaining fields use *) *
Name (Last, Fist, Middle Initial) *
Your answer
Address *
Your answer
Phone number (Include Area Code) *
Your answer
Alternate Phone (Include Area Code)
Your answer
Date of Birth *
MM
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DD
/
YYYY
Date of Enlistment or Commissioning *
MM
/
DD
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YYYY
Date of Discharge *
MM
/
DD
/
YYYY
Type of Discharge *
Branch of Service *
Did you serve at least 30 days Active Duty? *
Type of Service *
A copy of your responses will be emailed to the address you provided.
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