August 2009 - Minnesota Paralyzed Veterans

August 2009
T
Continuing to Serve
he Minnesota Chapter of the Paralyzed Veterans of America is a non-profit organization.
Minnesota Paralyzed
Our funding is primarily received from donations. The Paralyzed Veterans of America is
Veterans of America
the name of our parent organization, and is chartered by the Congress of the United States
One Veterans Drive
of America. All members of the Paralyzed Veterans of America, have sustained a spinal
SCI-238
injury or disease. If you have any questions, or you would like to make a donation to our
Minneapolis, MN 55417
organization, please write to the address or call the numbers listed on this page
Monday - Thursday:
ny and all articles that appear in this newsletter, is the opinion of the author of said
8:00 AM - 4:00 PM
article, and not necessarily those of its members, Board of Directors, or that of this
Friday:
organization.
Any advertising that appears in this newsletter, is paid for by the business
8:00 AM - 1:30 PM
or organization that placed the advertisement. The Minnesota Paralyzed Veterans of
Phone: 612-725-2263
America, by printing said advertisements, does not endorse and shall not be held liable
Toll Free: 1-800-663-6782
Fax: 612-726-9472
for any claims of any kind against said business or organization.
Email: mnpva@qwest.net
he Minnesota Paralyzed Veterans of America’s newsletter will be published 12
Executive Director
times per year. The editor and/or assistant may edit all articles for content,
Richard F. Jost
grammar, clarity and punctuation.
Phone: 612-467-1651
Email: rfjostmnpva@qwest.net
— Richard F. Jost, Editor.
Officers
President Charlie Wittwer
Vice-President Russ Osborne
Secretary Eric Webster
MNPVA Chapter
Treasurer John Christensen
Past President Eric Webster
Email Address
Volume 15, Issue 7
Board of Directors
Change
Leo Dondlinger – Todd Kemery
Northern Highlights
Tom Fjerstad – Dave Langsdale
We would like to inform
Bill Frisby – Dave Hallis
Sports Directors Report 3
everyone that the Minnesota
National Director
The Team 4
Thomas R. Fjerstad, PRP
PVA Chapter’s email address
National Service Offices
Membership Report 5
has changed. Please change
Jason Stephenson – 612-629-7022
your address book in your
Wheelchair Games pics 5
Senior Benefits Advocate SCI-141
email to the following correct
612-629-7021
Secretary’s Report 6
email address:
Vocational Rehab. Program SCI-139
President/Advocate/Legislation Report 6
mnpva@qwestoffice.net
One Veterans Drive
Minneapolis, MN 55417
Senior Benefit Report 7
Tami Andersen – NSO II
September 8
Federal Building Room 194B
St. Paul, MN 55111
Events and Birthdays 9
612-970-5988
Dj’s Logic 10
1-800-795-3609
FTS 612-970-5668
Spiritual Thoughts 11
Northern Highlights Staff
A Memorial Thanks 11
Editor Richard F. Jost
Circulation Dianna Way
A
T
Table of Contents
Northern Highlights
Advertising Rates
Please call the office for rates.
In Remembrance 11
Executive Directors Report 12
Member Application 13,14
Rollx ad 15
612-725-2263
or
1-800-663-6782
Four Wheeling 15
Sports Director’s Report – Todd Kemry
Greetings Minnesota chapter Members, Volunteers, and our other VIP mail recipients. We are very excited and proud to report to you
the results of our Minnesota athletes that attended this summers’ Veterans Wheelchair Games. Congratulation to our guys and a huge
thank you to our coaches and family members that helped our team prepare and participate in our events.
The 29th Games were held in Spokane, Washington this year and our team consisted of 16 athletes, 3 coaches, and 2 volunteers.
Of those athletes, we were happy to have two “new guys” make the trip with us; Shawn Shoen and Dale Haugen represented our
Minnesota Team in the Novice class and both were medal winners. In fact, Dale and Shawn left Spokane with more than one medal
each. The medal count this year was 47 total; 22 Gold, 13 Silver, and 12 Bronze. This year everyone had, at least, one medal which
hasn’t happened in a while.
Since we all did so well I wanted to introduce to you our athletes and their events they medaled in. In no particular order;
Hank Ebert; Gold-Air Rifle and Archery, Bronze-Field (Discus, Shot Put, Javelin each)
Bob Huber; Gold-Bowling, Silver-220 Power Chair and Motor Slalom
Andrew Bernstrom; Gold-Bowling, Silver-Swimming and Slalom, Bronze-Softball
Dave Hopkins; Gold-Bowling
Jerry Klemm; Gold-Power Soccer, Bronze-Air Rifle, Bowling and Power Slalom
Eric Webster; Gold-220 Power Chair and Motor Slalom, Silver-Motor Relay and Bowling
Todd Kemery; Gold-Swimming (Back stroke and Free Style each), Softball and Quad Rugby
Charlie Wittwer; Gold-Swimming (Backstroke and Free Style each), Silver-Slalom
Jesse Gonzales; Gold-Softball, Silver-9 Ball
Mike Hancock; Bronze-Motor Slalom and Bowling
John Christensen; Gold-Handcycle, Bowling and 9 Ball
Taum Ulrich; Silver-Handcycle and Bowling
Leo Dondlinger; Gold-Softball, Bronze-Weightlifting, and Shot put
Dale Haugen; Gold-Motor Slalom, Silver-9 Ball
Shawn Shoen; Gold-Shot put, Bronze-Javelin
Ken Walsh; Gold-Bowling and Power Slalom, Silver-Power Soccer and Field (Club)
There you are sports fans, our athletes who attended the 29th National Veterans Wheelchair Games and the events they medaled in. I
wanted to highlight one of our team members for his outstanding results in Handcycleing; John Christensen, who placed first in his
hand cycle event, did so in such a dominate manner, that John has been invited by Invacare to the Top End Hand cycle Demonstration
Team. Nicely done John!! We also had a couple of local T.V. celebrities Charlie Wittwer and Hank Ebert were pulled aside and
interviewed by KXLY Channel 4 News. Also in that interview were our own Coach Pat Kahler and his step daughter Jessica Peters.
There is a nice article to read at http://www.fairchild.af.mil/news/story.asp?id=123159714. The articles name is Veterans win more
than Gold. There is also video of about 85% of the events this year. Xable.com is the site to click on to see the games. Xable is a video
company that broadcasts over the net about all wheelchair sports events including the Veterans Games. I encourage all of you to click
on their site and watch us compete in our events. Check out the championship Quad Rugby and the Championship Softball videos.
The MNPVA Flame Throwers Wheelchair Softball team is headed for National Championships this year in Milwaukee, Wisconsin;
I’ll have results for you all in the next newsletter.
As always, call the office for anything sports or recreation related. We have a little summer left and there is plenty going on such as
fishing, bowling and trap shooting.
3
4
Membership Report ­– Dave Hallis / Dianna Way
Our current membership is at 336 with the breakdown as follows:
Service Connected = 154
Non Service Connected = 182
Please keep in mind to enlist new members when you are out in the community because we would really like to see our
membership increase. Veterans with a spinal cord injury or spinal cord disease and with an honorable discharge or retired
from the military are eligible for membership into our chapter.
The Minnesota PVA Chapter welcomes the following new members: Eugene Evans, James Graham, Jerome Jackson and
John Novicki. We look forward to seeing you all at any of our upcoming events. WELCOME!!
I would like to thank everyone who attended the membership meeting held in Rochester, Minnesota on July 30, 2009, at
Michaels’ Restaurant. Everyone in attendance had a great time and the food was excellent.
Reminder: The MNPVA Chapter annual banquet is scheduled for October 3, 2009, at the Sheraton Hotel in
Bloomington, Minnesota. Please mark your calendars and plan on attending this event. The invitations will be in the mail
within the next few weeks.
Note: A membership meeting will be held in Hinkley, Minnesota at Toby’s Restaurant on September 22, 2009 starting at
11:30am. Please call the MNPVA office at 612-725-2263 or 1-800-663-6782 to reserve your spot.
5
Secretary’s Report – Eric Webster
I would like to inform the membership of the nominees for the upcoming election in 2009.
President – Charlie Wittwer (incumbent)
Vice President – Russ Osborne (incumbent)
Treasurer – John Christensen (incumbent)
Secretary = Eric Webster (incumbent)
Two nominees for Board of Directors are:
Tom Fjerstad (incumbent)
Todd Kemery (incumbent)
The ballots will be mailed to the membership by August 15, 2009. Please remember to vote and return your ballot by the
deadline of Monday August 31, 2009 by close of business day. All ballots received after this date will not be counted.
President/Advocacy/Legislative Report – Charlie Wittwer
Hello Everyone!
As the summer continues its way toward our beautiful fall weather, the PVA world continues to spin in the right direction.
Tom Fjerstad and Richard Jost are getting ready to represent us at the Annual PVA Convention in balmy Miami from
August 17th – 22nd, 2009.
We are settling into our office within the new SCI Building with all the new state of the art equipment at the Minneapolis VA Medical
Center. It is great being in the middle of everything and to know what is going on with our members instead of being isolated.
Tom Fjerstad and Todd Kemery are getting settled into their office at the Veterans Building at the State Capital in St. Paul, Minnesota. It
is a tremendous asset to our members to be in the hub of the Legislative world.
Next I would like to discuss the recently attended 29th Annual National Veterans Wheelchair Games held in Spokane, Washington from
July13th – 18th, 2009. We are very fortunate to have had 16 athletes, 3 coaches, 2 press volunteers, 1 photographer along with several
family members who are a great asset to the team because they also contribute a lot of time and effort to the team while at the games. They
would cheer on their athlete, attended other team members’ events to cheer them on and assisted the athletes wherever needed. The athletes
were: Charlie Wittwer, Todd Kemery, John Christensen, Jesse Gonzales, Ken Walsh, Bob Huber, Eric Webster, Andrew Bernstrom, Mike
Hancock, Hank Ebert, Dale Haugen (novice), Shawn Shoen (novice), Taum Ulrich, Leo Dondlinger, Jerry Klemm and Dave Hopkins. The
coaches were Kory Badertscher, Becky Wittig and Pat Kahler whom we thank for their dedication and passion for our Veteran athletes to
do the possible against sometimes the insurmountable odds. Our newly designated “press team’ were Cara Kahler and Jaye Peters a dynamic
Mother/Daughter Duo who outdid themselves and kept us all informed via word of mouth and new just this year a brilliantly published
newsletter. Also new this year the MNPVA Chapter had their own personal photographer, Bill Eilers, who traveled to the games with them.
Bill’s wife (April) was also at the games but she was there to cover the entire games for the VA Medical Center. They worked endless hours
and the results will be sown on these pages of the newsletter.
The banquet is scheduled for Saturday October 3, 2009, at the Sheraton Hotel in Bloomington, Minnesota. So mark your calendars now
and plan on attending.
Have a good month and remember to be kind.
Take care and be kind!!
6
Senior Benefit Advocate’s Report – Jason Stephenson
Survivor’s and Dependents’ Educational Assistance Program
Dependents’ Educational Assistance provides education and training opportunities to eligible dependents of certain
veterans. The program offers up to 45 months of education benefits. These benefits may be used for degree and
certificate programs, apprenticeship, and on-the-job training. If you are a spouse, you may take a correspondence
course.
Remedial, deficiency, and refresher courses may be approved under certain circumstances.
In order to be eligible for educational assistance you must be the son, daughter, or spouse of:
- A veteran who was rated permanently and totally disabled at the time of death or is permanently and totally disabled as
the result of a service connected disability. The disability must arise out of active service in the Armed Forces.
- Effective December 23, 2006; a service member who is hospitalized or receiving outpatient treatment for a disability
that will be rated service connected permanent and total and is likely to be discharged for that disability.
If you are a son or daughter and wish to receive benefits for attending school or job training, you must be between the
ages of 18 and 26. Marriage is not a bar to this benefit.
If you are in the Armed Forces, you may not receive this benefit while on active duty.
Please note that if a dependent receives education benefits under this program; and the veteran is receiving additional
compensation for this dependent on his or her compensation award; the dependent must be removed from the veteran’s
compensation award effective the first day of school or training. A veteran cannot have their dependent on his or her
award if at the same time; the dependent is receiving this education allowance.
Effective October 10, 2008; if the VA rated the veteran permanently and totally disabled with an effective date of three
years from discharge; a spouse will remain eligible for educational benefits for 20 years from the effective date of the
rating.
If a son, daughter, spouse, or surviving spouse is interested in applying for education benefits; they should contact their
local Paralyzed Veterans of America National Service
Officer and complete a VA Form 22-5490 Application for Survivors’ and Dependents’ Educational Assistance. You
should also ensure that your selected program is approved for VA training prior to starting a course. Once you have
completed a 22-5490, and the
VA has approved your course of training, than a VA Form 22-1999 Enrollment
Certificate from your school, must be completed once a month while attending training.
If you have any questions regarding educational benefits for spouses and dependents; please contact your local
Paralyzed Veterans of America National Service Officer.
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September 2009
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Office
Closed
Patriot Day
Labor Day
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25
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Citizen
Constitution Day
Grandparents Day
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Labor Day
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Birthstone: Peridot • Flower: Gladiolus8
Schedule of Events
August 15
Deadline to have ballots mailed to members
August 17-22
National PVA Convention and Annual Meeting in
Miami, Florida
August 22
4 Wheelin opportunity in Isle, Minnesota on the Red
Dot Trail sponsored by Capable Partners; everybody
is asked to meet at Pat’s Bait Shop on Highway 47
by 10:00 a.m. at the very latest. Lunch will be served
August 25
BOD Meeting
August 31
Election ballots are due in the MNPVA office by close
of business day at 4:00 p.m. with no exceptions!!
September 1
Bingo Vets Home – 7:00 p.m.
September 2
UVLC Meeting – 9:30 a.m.
September 7
Labor Day – Office Closed
September 8
Fishing from 1:00 p.m. to 5:00 p.m. at Mille Lacs
Lake in Isle, Minnesota at Scenic Bay Resort; please
call the office if you plan on attending so we have
enough food for everyone
September 11
Patriot Day
September 13
Grandparents Day
September 15
BOD Meeting
September 17
Citizenship (Constitution) Day
September 22
Autumn Begins
4
Hospital Visitation: Monday through Friday
Bowling South: Thursday mornings starting at 11:00
a.m. at the Eden Prairie Bowling Lanes in Eden
Prairie, Minnesota
Bowling North: Thursday afternoons starting at 2:00
p.m. at Bowlers Advantage/Bunkie’s Bar & Grill Bowling Lanes in Chisago, Minnesota
Birthdays
1
Manley J. Knutson
Richard J. Stang
William A. Thorson
2
Walter E. Dochow
Edward E. Kell
3
Mark A. McGarvey
Aldeane W. Peterson
Gregory S. Schleifer
Thomas E. Shrader
4
Larry D. Grimm
Bradley L. Smith
13
Robert E. Hanson
14
Duane R. Flaten
Leslie J. Tomporowski
15
Tom Boettcher
17
Suzanne M. Byrne
Cynthia D. Sjoberg
18
Kenneth P. Juetten
21
Fred Woodward
6
John K. Christensen
22
Matthew D. Bachman
9
Cecil J. Noggle
Richard M. Visser
24
Gregory J. Stafford
10
Pat A. Hallis
William A. Werner
11
Paul C. Ennis
Russell E. Osborne
12
Steve J. Despiegelaere
Monica M. Stanton
25
Michael Diedelich
Mark F. Mulvihill
26
Frank J. Budlowski
29
Dale M. Tyson
30
Shannon L. Matthews
Please call the MNPVA office if you plan on attending any of the above activities at
612-725-2263 or 1-800-663-6782 or via email at mnpva@qwest.net
9
Dj’s * L*ogic
A few MNPVA relevant websites of interest for the computer literate and/or wannabes:
Paralyzed Veterans of America PVA http://www.pva.org/site/PageServer
MN Paralyzed Veterans of America MNPVA http://mnpva.org/
Department of Veterans Affairs DVA http://www.va.gov/
Minnesota Department of Veterans Affairs http://www.mdva.state.mn.us/index.htm
Americans with Disabilities Act ADA http://www.ada.gov/
MN State Council on Disabilities MSCOD
http://www.state.mn.us/portal/mn/jsp/home.do?agency=MSCOD
National Multiple Sclerosis Society http://www.nationalmssociety.org/index.aspx
Minnesota Multiple Sclerosis Society
http://www.nationalmssociety.org/chapters/MNM/index.aspx
Multiple Sclerosis Society of America MSAA http://www.msassociation.org/
POLITICIANS
Minnesota’s elected National & State officials & State-By-State
http://www.wrhammons.com/minnesota-senators-representatives.htm
LINKS TO HELP FIND OLD MILITARY BUDDIES (preliminary)
Classmates.com http://www.classmates.com Much more than just high school classmates
Military.com http://www.military.com/
Vet Friends.com (costs $’s) https://www.vetfriends.com/new_member/index.cfm
US Navy (free) & good http://www.decklog.com/homeport.asp
US Navy Seabee (free) & good http://www.nsva.org/
US Coast Guard (free) & good http://www.fredsplace.org/
*This does work, as I found 6 buddies of 40 years ago; and we’re now GOOD buddies all
over again! So please, if you have one of those special websites you use to find old friends,
send a copy to the office, and we’ll add it to the list.
JUST FOR FUN
Start Tribune Cryptogram http://www.uclick.com/client/sto/cy/
Start Tribune Sudoku http://www.uclick.com/client/sto/sudoc/ (my personal favorite)
NY Times crossword
http://www.nytimes.com/ref/crosswords/classicpuz.html?scp=4&sq=crossword%20
puzzle&st=cse
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Remembering our Deceased members
Steven Friese
Howard Hanson
George Olson
The Minnesota PVA Chapter was notified that the following
MNPVA member have passed away since our last newsletter.
The chapter extends its deepest sympathies to the families and
friends of the deceased members.
MEMORIAL THANK YOU
The Minnesota Paralyzed Veterans of America would like to thank the family of DeForest
D. Corcoran, Jr. (Corky) for their generous donation to our organization. He was a World
War II Navy Veteran.
The Minnesota Paralyzed Veterans of America would also like to thank the family and
friends of past member Gilbert Sagdalen for their very generous donations in his memory.
Spiritual Thoughts with
Leo Dondlinger
Revelation 21:21
The twelve gates were twelve pearls, each gate made of a single pearl. The great street of the city was of pure
gold, like transparent glass.
We can remember all the fun we had at the games and winning a gold medal. I think heaven will be much better. The medals will last our lifetime on earth but the glory of heaven will be forever. Winning medals or not,
we all made the journey; let us be as diligent to make the journey to heaven where everyone receives the gold.
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Executive Director – Richard F. Jost
My article will be the Viet Nam Story I received from Sarah Graves
from the State Capital in tribute to all Viet Nam Veterans which was
held on Saturday June 13, 2009.
Viet Nam Era Veterans Day – Sarah Graves – Information Officer
Nearly 40 years after the official end of the Vietnam War the
Minnesota community gathered to say thank you and salute those
who sacrificed so much during this time.
The Minnesota Honor Vietnam Era Veterans celebration, hosted
by the Minnesota Department of Veterans Affairs, brought together
over 5,000 individuals, Veterans and family members at the State
Capitol Grounds in St. Paul to celebrate and honor all those who
served during the Vietnam War era.
The initial idea for this event came from Richard Jenkins, Vietnam
Veteran and the past Department Commander of the Military Order
of the Purple Heart Department of Minnesota. Jenkins, along with a
large planning committee which included representatives from over
twenty Veterans and community organizations, spent more than a
year organizing this day of honor, respect and remembrance.
The day was filled with tears, embraces, laughter and reflection on
how this turning point in American history continues to impact our
community.
“The event was a wonderful success, It was a moving experience to
reconnected with so many friends and to meet new ones,” said Clark
Dyrud, Minnesota Department of Veterans Affairs Commissioner.
“Since the event we’ve received hundreds of thank you messages
from Veterans and individuals who reconnected with forgotten
friends and were able to reconnect with the community,” he
continued.
The event was highlighted by a formal program featuring keynote
speaker Jon Hovde. Hovde, a Purple Heart recipient and Vietnam
Veteran spoke about his combat experience and life after war. His
moving, and often humorous words had the audience gripped in
silence one moment and laughing the next. Governor Tim Pawlenty
and Minnesota Department of Veterans Affairs Commissioner Clark
Dyrud also spoke.
During the day attendees enjoyed the Traveling Vietnam Memorial
Wall, a military equipment and vehicle display by the Crystal
Military Museum, several flyovers, the artwork of Carol “Les”
Fordahl, a vintage car show and much more. For a recap of the
event and to view photos visit www.mnhonorveitnamvets.org.
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PARALYZED VETERANS OF AMERICA
MEMBERSHIP APPLICATION
An individual is eligible for membership by meeting the following criteria: (1) is a citizen of the United States;
(2) was regularly enlisted, inducted, or commissioned, and was accepted for or on active duty, in the Army, Navy,
Marine Corps, Air Force, or Coast Guard of the United States or an ally of the United States; (3A) was separatedfrom
the service in the Armed Forces under conditions other than dishonorable; or (3B) is on active duty or must
continue to serve after the cessation of hostilities; and (4) has suffered a spinal cord injury or disease (such as MS,
ALS), whether or not service connected in origin. Membership is free. Complete and mail the application to:
PVA Membership Department, 801 18th Street, NW, Washington, DC 20006 or to the chapter of choice.
800-424-8200 • www.pva.org
Chapter Name: _____________________________________________________________________________________
Minnesota PVA Chapter
First Name: ___________________________ Middle Initial: ________ Last Name: ____________________________
Date of Birth: _______ / _______ / _______
month
Male
date
Social Security Number: _______________________________________
year
Female
Are you a United States citizen?
Yes
No
Address: __________________________________________________________________________________________
City: _________________________________ State: ___________________________ Zip: _______________________
Home Phone: ______________________________________ Other Phone: ______________________________________
Email: _______________________________________________________________________________________________
VETERAN STATUS INFORMATION
DATE(S) OF
MILITARY SERVICE
Start Date
End Date
month/date/year month/date/year
TYPE OF
SEPARATION
Discharge (D) or
Retirement (R)
BRANCH OF SERVICE
D
or
R
Army
Air Force
Navy
Marine Corps
Coast Guard
D
or
R
Army
Air Force
Navy
Marine Corps
Coast Guard
Have you ever been discharged under conditions that are less than honorable?
Is your spinal cord injury or spinal cord disease service connected?
Yes
Yes
No
No
DISABILITY CLASSIFICATION
SPINAL CORD INJURY
SPINAL CORD DISEASE
(Complete ONLY if you have a traumatic spinal cord injury)
(Complete ONLY if you have non-traumatic spinal cord disease)
Date of Injury: _______ / _______ / _______
Date of diagnosis/onset of condition:
Injury Level:
C1-C08 Cervical
T01-T12 Thoracic
L01-L05 Lumbar
S01-S05 Sacral
Cause of SCI:
Vehicular (auto, motorcycle, aircraft, bicycle, etc.)
Violence (gunshot, stabbing, explosion, etc.)
Pedestrian (hit by car, etc.)
Sport or recreation (swimming, diving, etc.)
Flying or falling object
Medical-surgical complications
Other traumatic injury ___________________________
Unknown
_______ / _______ / _______
Specific disease:
Multiple Sclerosis
Poliomyelitis
Amyotrophic diseases (lateral sclerosis, transverse myeltis)
Syringomyelia
Other (specify) ________________________________
13
LEVEL OF FUNCTION
Indicate your level of function:
Paraplegia
Quadriplegia
Hemiplegia
No paralysis at this time
GENERAL INFORMATION
Please check the appropriate box or fill in the blank of each of the categorical that best describes your present status.
This important information enables the PVA to compile data for the effective implementation and support of our programs.
EDUCATION (highest level)
Less than high school graduate
High school graduate/GED
Some college or trade school
Associate’s degree
Bachelor’s degree
Attended graduate school
Graduate degree
Other
MARITAL STATUS
Divorced
Married
Never Married
Separated
Widowed
TYPE OF RESIDENCE
Apartment
Assisted living facility
Single-family home/condominium
State/veterans retirement home
Nursing home
VA hospital
VA nursing home
Other ________________________
CURRENT EMPLOYMENT STATUS
Employed full time
Employed part time
Self-employed
Unemployed
Unemployed due to disability
Retired
Other ________________________
RACE/ETHNICITY
Asian or Pacific Islander
Black, not Hispanic/Latino origin
Hispanic/Latino
Native American or Alaskan Native
White, not Hispanic/Latino origin
Other ________________________
SOURCE(S) OF INCOME
NEXT OF KIN INFORMATION
Relationship: ____________________________________
Name: _________________________________________
Same as member address on front of form
Address: _______________________________________
City: __________________________________________
State: _______________________ Zip: ______________
Phone: _________________________________________
(check all that apply)
Employment
Gifts/Other
Private pension
Social Security
VA compensation
VA pension
Worker’s compensation
OTHER CONTACT INFORMATION
(someone other than next of kin)
Relationship: ____________________________________
Name: _________________________________________
Address: _______________________________________
City: __________________________________________
State: _______________________ Zip: ______________
Phone: _________________________________________
The Veterans Benefits Department advocates for quality health care for our members and can assist you to obtain the appropriate
benefits available as a result of your military service. Is PVA presently your benefits representative?
Yes
No
If yes, I have no objection and hereby permit PVA Service Officers to provide information to the PVA National Membership
Department that pertains to my qualifications for membership.
I declare that I have read and meet the qualifications. I understand that my
Office Use Only
membership could be revoked if any information provided is inaccurate.
Date Received: ____________________________
Applicant’s Signature
Member ID#: ______________________________
Processed Date: ___________________________
Date
14 3/08
4 Wheeling Opportunity
Capable Partners is offering a 4 wheeling event on Saturday August 22, 2009, in Isle, Minnesota
on the Red Dot Trail. Everyone will meet at Pat’s Bait Shop on Highway 47 at 10:00 a.m. Lunch
will be served.
If anyone is interested in trying 4 wheeling out, please call Greg Waite at 763-786-3999
for more information about this event.
Your Life. Your Ride.
Find your ride. Live your life.
Visit www.rollxvans.com for the latest inventory, pricing
and rebates. Or call 1-800-956-6668,
15
Minnesota Paralyzed Veterans
of America
1 Veterans Dr. SC1-238
Minneapolis, Minnesota 55417
First Name: ____________________________________________ MI:____________________
Last Name:_ __________________________________________________________________
Address: _ ____________________________________________________________________
____________________________________________________________________________
City: ____________________________________ State:______________ Zip:______________
Home Phone: (_ _____ ) _____________________E-mail:_______________________________
Birth Date:_ ____/_____ /_____ Membership ID Number _______________________________