Join Veterans Recovery Network (Membership Application) Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLast(Membership Applicant)Name SuffixSelect OneEsq.Jr.Sr.M.D.IIIIIIV(if applicable) have thirty the Gender *Select OneMaleFemaleOther/Not SpecifiedDate of Birth *(MM/DD/YYYY)Spouse's First Name(if applicable): Nickname(if applicable):Branch of Military Served *Select OneArmyAir ForceMarine CorpsNavyCoast GuardNational Guard/Military Reserve(Please select one)Email Contact *EmailConfirm EmailStreet Address *City/Town *State/Province *(Use two-letter abbreviation; e.g,, New York: NY; California: CA)Zip/Postal Code *Country *Select OneUSAPhilippinesMexicoMicronesiaPalauMarshall IslandsOther/Non-U.S. LocationPlease specify your primary country of residence. If you reside in a territory of the U.S. (e.g., PR, GU, MP, VI, AS) please input as a state above, and select ‘USA’ here.Phone Contact *(XXX-XXX-XXXX)Type of Membership *Select OneVeteran Member (1-Year) – New MembershipVeteran Affiliate (1-Year) – New MembershipVeteran Member (Lifetime Membership)Renewal (Annual Membership)Please select the type of membership you are applying for today (see drop down menu above). There is a one-time application fee of $25 for all new members. Note: Only Veteran Members may join as lifetime members. If you are a veteran’s spouse or child, please join as ‘Veteran Affiliate.’Payment Method *Select OnePaypalVemmoCashappVisa/Mastercard/AMEXCheck/Bank TransferOtherPlease select the method of payment you wish to use for fees related to this Application as disclosed above. You will receive a payment request link via email or SMS text message.How I Heard About VRN *Select OneAnother Active VRN MemberVRN Employee/VRN EventGoogle/Social MediaOtherHow did you hear about Veterans Recovery Network?I, the "Membership Applicant," hereby declare that information on this Application to be true and correct, have chosen to submit this Application for membership at Veterans Recovery Network Inc., for immediate review before the Board of Membership Council, becoming immediately effective under a provisional status for thirty days from the submission and approval date of this Application. *I AGREEPlease select “AGREE” above only if you accept and agree to the terms and conditions under the respective organizational bylaws of Veterans Recovery Network (“VRN”) acknowledged under this Agreement. (See VRN Bylaws at https://vetsrecovery.org/bylaws)Member Applicant Signature [s/:] *(Please print your first/last name)Submit