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PVA Membership Application

Join the more than 16,000 proud members of Paralyzed Veterans of America! As a member, you’ll become part of a family of men and women united to make the world better for veterans and all people with disabilities.

First Name

Middle Initial

Last Name

Street Address

City

State/Region

Country

Postal Code

Primary Phone Number

Mobile Phone Number

Gender

Ethnicity

Are you a U.S. Citizen

YesNo

Date of Birth

Select a PVA Chapter

Have you been discharged under conditions that are less than honorable?

YesNo

Do you have a spinal cord injury or disease?

YesNo

Please specify your paralysis type, if applicable:

Please select your specific disease, if applicable:

If other, please specify.

Veterans with a SCI/D (excluding those with MS and ALS) must have an associated neurological impairment to be eligible for PVA membership. Please specify your neurological impairment.

You can use the Control key on Windows or the Command key on Mac to select multiple options.

Is your spinal cord injury or disease service-connected?

YesNo

How did you hear about us?

If you heard about us from a source not listed above, please specify.

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Contact Information