Join VLWA

Join VLWA

Use this form to apply for VLWA membership or renew an existing membership.

Contact Information

* Inidcates the information is required to process the form.
First Name*:
Last Name*:
Title/Position:
Affiliation/Company:
Street Address*:
City*:
State*:
Zip Code*:
Day Phone:
Evening Phone:
Fax:
E-mail Address:

Specify a type of membership

Is this a renewal?	Yes	No
If so, I have been a member since:

Individuals (Includes annual subscription to the VLWA newsletter)

Annual $15

Professional/Business $50

Contributing $250

Sustaining $500

Individual affiliated with
active group $10

Groups (Includes the the number of VLWA Newsletter copies indicated)

0-500 Members (5) $50

501-1,000 Members (10) $100

1,000-2,000 Members (20) $150

2000+ (20) $200

Type of Business

How will you pay dues?

Bill me at the address above.

I will send a check.
Make payable to "VLWA Membership" and mail to:

6040 Waterworks Road
Norfolk, Virginia 23502

Also, include the following so we can match your check to your membership:

Name on check

Check number

Amount

Send in the form

When you have provided all the necessary information, press SEND to send us the form electronically. If you wish, you may print out this form and submit it by mail along with payment.

MORE INFORMATION