NORVA MEMBERSHIP FORM

Name:

Address:

City/ State/ Zip:

Phone Number:

Fax #:

E-mail:

Country of Service:

Dates of Service:

Peace Corps Assignment:

Current Occupation/ Employer/ Phone:

Membership Categories:

NORVA and NPCA
Individual- $50.00         Family- $65.00

NORVA and NPCA and another group
Individual - $65.00        Family- $87.50
three years:
Individual- $135.00           Family- $180.00

State other group____________________________

NORVA only- $15.00

Contribution $______________________________

State project this contribution is to be used for:

__________________________________________

----Check here is you do not want your name shared with
other organizations.



Make checks payable to:

Northern Ohio Returned Volunteer Association
C/O Carolyn Myers, Membership Chairperson
2560 N. Moreland Blvd. #303
Shaker Heights, Ohio 44120    

for further information,
email membership@norvaohio.org