Fox Valley Electric Auto Association
 Membership Application Form
Version 2014-01-01

 

Name:______________________________________________________ 

Address:____________________________________________________ 

City, State Zipcode:___________________________________________

Phone:_________________________________  Phone Type: Home ___ Work ___ Cell ___

Email:______________________________________________________

Please check one:     New Member _____ Renewal _____

Comments:_________________________________________________

How did you hear about the FVEAA ? _______________________________

Membership Types and Annual Dues 

The FVEAA offers these types of memberships (please circle your choice):

Individual  $   20
Business  $ 100
Premier Business  $ 250
Charter Business  $ 500

Newsletter Delivery Types (please circle your choice):

No Newsletter
Electronic

Please make your check payable to "FVEAA" and postal mail it with this membership application form to:

FVEAA
PO Box 214
Wheaton, IL 60187-0214
Attn: Membership