Veterans Initiative for Therapeutic Arts
Veterans Initiative for Therapeutic Arts Membership Registration

Contact Information

* First Name:

MI:
* Last Name:

Nickname:
* Email Address:

* Date of Birth:
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* Gender:

* Mailing Address Line One:

Mailing Address Line Two:
* City:

* State:
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* Zip Code:

Cell Phone:
Cell Phone Provider:
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Home Phone:
Work Phone:
Work Extension:
Preferred Phone:
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Preferred Method of Contact:
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Best Time To Contact:

Military Information

* Military Service?
* Which Branch (if yes):
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* Current Military Status:
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Active Years Start Year:
Active Years End Year:
Combat Campaign:

Membership Fees

Our Membership Fees are $100 annually or $10 per month. If you would like to be a part of the program, but can't afford to pay the fee at this time, please select "Financial Hardship Consideration" and send an email to info@vitaarts.org.
How would you like to pay your membership fees?