Application for NAVAC Professional Membership

There are two categories of membership. Category A members shall have
all rights and Privileges of membership. Category B members shall have
all rights and privileges of membership, except the right to vote, the right
to hold office as either an officer or Board member, and the right to serve
as a committee chairperson.

Category A members include any chaplain who is currently employed by theDepartment of Veterans Affairs in any of the following ways: a full-time employee, a part-time employee, an intermittent chaplain, a fee-basis
chaplain or a contract chaplain.

Category B members include retired and former VA chaplains, other
federal chaplains to include but not limited to military chaplains, endorsers,
and allied professionals with an interest in the VA chaplaincy.

Membership applications are to be sent to the Chairman of the Board of Directors. Appeals due to a person’s application not being accepted, is
to the Board of Directors.

The fee for Professional Membership each year is $30.00, due and
payable in January of each year. Should payment not be received by
March 1 of each year, membership becomes inactive until such payment
is made.

APPLICATION FOR NAVAC PROFESSIONAL MEMBERSHIP

Name ___________________________________________________

Mailing Address:    ________________________________________________________

Work phone ___________________________
Home phone __________________________

E-mail address:__________________________
FAX: __________________________

VA Medical Center Address ________________________________________________________

Citizenship (USA required)  yes  no

Current position or employment:

Present association with VA
         _______ current chaplain, VA
         _______ retired chaplain
         _______ military chaplain
         _______ endorser
         _______ Allied professional, please identify
         _______ Other, please identify 

Please remit this completed application, along with the $30.00
membership fee to:

NATIONAL ASSOCIATION OF
VETERANS AFFAIRS CHAPLAINS

CHAPLAIN TED BLECK-DORAN
CHAIR, BOARD OF DIRECTORS
P.O. BOX 787
MOUNTAIN HOME, TN 37684-0787