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is a 501 (c) (3) non-profit organization gay, lesbian, bisexual and transgendered active duty, reserve and veteran service members, challenging the DOD's policy of discrimination with regard to sexual orientation, whether actual or perceived. Membership in AVER is open to all who support the goals of the organization and does not suggest or imply sexual orientation of any of its members. All membership information is strictly confidential, as directed by the National Constitution, within the limits of applicable laws.

(Formerly known as GAY, LESBIAN AND BISEXUAL VETERANS OF AMERICA, INC.)
Please Print Legibly. All information submitted will be maintained confidentially.
Initial Application____ Renewal _____ Update only____
Date of Application: ______ / ______ / ______
How did you learn about AVER? __________________________________________
Personal Information
Name (circle one): Mr. Ms. Rev. Dr._____________________________________
Street Address or PO Box:____________________________ Apt.: ____________
City: _________________________ State: ______ Zip: _____________ + ____________
Phone: (____)____-___________ Fax: (____)_____-___________ E-mail: ______________
Date of Birth: ______ / ______ / ______ Occupation: ___________________

Service Background  Proof of service: DD214, or Mil. ID;. Branch of Service and Dates are mandatory.
Branch of Service: _______________________ Active or Reserve Now? Yes _____ No _____
Dates of Service: From: ______ / ______ / ______To: ______ / ______ / ______
Highest Rank Held (circle one): E 1 2 3 4 5 6 7 8 9 W 1 2 3 4 5 O 1 2 3 4 5 6 7 8 9
Please list additional service information including honors, medals, citations, letters of commendation and appreciation from your service career on the back of this form.

Areas Of Interest
Please indicate where you are able to help:
Legal Assistance Veterans Issues (HIV,etc) Press Contact / Releases
Legal Observer ROTC Issues Local Area Contact Person
Fund Raising Public Speaking Education & Awareness
Newsletter Counseling Other:
Please indicate where you might need assistance:
 
AVER Membership Type
Membership (Includes National and Chapter if available) $35.00 Please Make Payable to:
Corporate / Organizational Sponsor $50.00 AVERNY
Life Member (One time payment) $500.00

PO Box 150160
Amount Enclosed: $_______

Kew Gardens, NY 11415
All Memberships expire on 30 September. NEW Memberships effective after 1 March will expire on 30 September of the following year. 
Chapter Use Only: Rec'd: ______ / ______ / ______ National Use Only: Rec'd: ______ / ______ / ______ 

AVER Membership Form 6/2002, AVERNY modified 0803.   All previous versions obsolete and will be returned for correction.