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
         _______ CPE Resident
         _______ 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:

NAVAC Certification Committee Chair

Chaplain David E. LeFavor, D.Min, BCC
Dayton VA Medical Center
Chaplain Service Code 125
4100 West Third Street
Dayton, OH 45428


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 the Department 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 CPE residents, 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.