Organization > Chapters > Northern California > Members > Membership Form
VRA Northern California Chapter Membership Form – 2005
Name: _______________________________________________
Title: ________________________________________________
___ Please keep my information the same as it appeared in the 2004 directory.
Preferred Address for Mailings: ___ Home ___ Work
Work Address:___________________________________________________
_______________________________________________________________
_______________________________________________________________
Work Phone No: _________________________________________________
Work Fax No: _________________________________________________
Home Address:___________________________________________________
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Home Phone No: _________________________________________________
Email: _________________________ Fax No: _________________________
Print out this form, fill it in, and mail it with your membership dues, $10.00. Make cheques payable to "VRA - N. Ca. Chapter." Mail to:
Andrée LeBourveau
131 Magnolia St.
Santa Cruz, CA 95062
