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Circle One--->   Renewal / New member / Change of address

Please PRINT

Name _________________________________________________________

Address ________________________________________________________

Town/City ______________________________________________________

State _______________________________ Zip ________________________

Telephone ______________________________________________________

E-mail _________________________________________________________

New member?
How did you hear about VOCA? ________________________________________

Dues are for a calendar year: 1 year $10.00, 5 years $40.00, and lifetime is $200.00 (individual members ONLY). A new member joining in Oct or Nov or Dec will have the dues paid applied to the following year.

I want to make a donation to the Leon Dean Permanent Fund in the amount of $___________.

Make check payable to VOCA and mail to:
Barry Trutor
31 Matthew Avenue
Burlington, VT 05408