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 ? _______________________________
A. Membership Types and Annual Dues
The FVEAA offers these types of memberships (please circle your choice):
| Individual | $ 15 |
| Family | $ 20 |
| Business | $ 100 |
| Premier Business | $ 250 |
| Charter Business | $ 500 |
B. Newsletter Delivery Types (please circle your choice):
| No Newsletter | $0 |
| Electronic Only | $0 |
| Postal Mailed Only | $15 |
| Postal Mailed and Electronic | $15 |
| TOTAL DUE (A+B): | _______________ |
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