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

Please PRINT

Name ____________________________________________#____________

Address ________________________________________________________

Town/City ______________________________________________________

State _______________________________ Zip ________________________

Telephone ______________________________________________________

E-mail ________________________________________________________

Check here ___ to receive your quarterly newsletter by email only. Money saved on printing and postage goes directly to preservation projects.

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