CRVC-EGA Membership

$50.($25.) Primary Membership
$15. Plural Membership (NER)
$18. Plural Membership (not NER)

For a membership card, please enclose a SASE.

Amt. Pd. ____________

Check #  ____________

Date Pd. ____________
    (keep as your receipt)

CRVC-EGA Membership and Address Change Form

Mail your completed form to: Suzanne Newton, CRVC-EGA Membership, 14 Madison Lane, West Simsbury, CT 06092. Make check payable to CRVC-EGA. Enclose SASE for membership card.

          __ Address Change
          __ CRVC Primary Membership ($50) ($25 until Dec. 31)
          __ Plural Membership, Primary Chapter in New England Region ($15)
          __ Plural Membership, Primary Chapter not in New England Region ($18)

Name:               ____________________________________________________

Address:         ____________________________________________________

City, ST, ZIP  ____________________________________________________

Phone:            _______________________ Email:________________________

Primary Chapter:   ________________________________________________

Membership No.  _______________________   Total Enclosed $___________

A Short Questionnaire:
Can you volunteer your time to CRVC:        __ yes          __ no

Do you have experience with (circle):
    Accounting     Computers/MSPublisher     Business/Management     Advertising/Publicity

Would you like to participate on a Program Committee?      __ yes      __ no

Other interests or ways you may want to volunteer: _______________________________