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Membership Type:
$10 Basic
$25 Extended
$50 Family
$75 Business/Organization

Name of Member or Contact Person:
(in case of Family or Business/Organization membership)
Mr.
Ms.
First Name:     
Last Name:  
and/or Business / Organization Name:  

Address of Member or Contact Person:
Address & Postal Code:  
Phone Numbers:  
E-mail Address:  
     
I express my support to, and accept VIRCS’ mandate by filling out this application. I, therefore, agree to abide by VIRCS’ policy for its members.

Tax receipts will be issued for all gifts.
*All amounts beyond the basic $10 membership fee are tax-deductible