PVA Central Florida Membership Application – Paralyzed Veterans of America Central Florida Chapter

Applicant information

Tell us about yourself

First name

Middle initial

Last name

Email

Primary phone

Mobile phone

Date of birth

Chapter

Gender

Race / ethnicity

Address

Where should the chapter reach you?

Street address

City

State / territory

Postal code

Country

Eligibility

PVA membership qualifications

Are you a U.S. citizen or citizen of a U.S. territory? Yes No

Was your military discharge other than dishonorable? Yes No

SCI/D or related condition

Paralysis type, if applicable

Neurological impairment or other eligibility details

Supporting documents

Upload now if you already have them

These files are optional. If you do not upload them now, PVACF can follow up with instructions. Accepted: PDF, JPG, PNG or WebP, up to 12 MB each.

Download the PVA Physician's Statement form →

DD-214 or DD-215

Medical evidence / physician statement

Proof of U.S. or U.S. territorial citizenship

Final details

Communication and certification

How did you hear about PVA Central Florida?

I would like to receive PVA/PVACF communications by text or phone at the mobile number I provided. I can opt out later.

I certify that the information above is accurate and authorize PVA Central Florida to review this application, contact me about membership, and coordinate the application with Paralyzed Veterans of America.