Vale Club, Inc.
Membership Registration 2016-2017
Applications for Vale Club, Inc. membership for the upcoming year September, 2016 – June, 2017 begins in June. Applications and dues must be received no later than September 15, 2016 to be listed in the membership handbook. (Applications for new members only will be accepted year round, however, there will be no pro-rating of membership requirements.) A handbook addendum with additions and corrections will be published in the newsletter in January. Please mail form and two checks (made out as indicated below), to Ronniejean Irvin, 10909 Blue Roan Road, Oakton, VA 22124. Contact her at (703) 273-4113 or with questions.
___ Renewal ___ New ___ Returning Former Member
Name (last) ______(first) ______
Please fill in ONLY if “New” member or if information has changed from last year. This information will be printed in the handbook (max of 2 phone numbers). E-mail will be used for Vale Club newsletter & news alerts.
Address (street) ______
(city)______(state) ______(zipcode) ______
Phone (home) ______
(second #) ______is it a WORK CELL BEEPER (circle one)
E-mail ______(please print clearly!)
Birthday (month/day) ______
Spouse’s Name ______
Names of children and year of birth (for example, “Joe 94”):
______
Summary of Payments due – please submit TWO checks as indicated below:
1. VALE CLUB (please write check to Vale Club)
Dues $40.00
2-Hour Volunteer Fulfillment OR $40.00 buy-out _____
Past Membership Obligations, if applicable _____
2. FRIENDS OF VALE SCHOOLHOUSE (FVS) (please write check to FVS, Inc)
Tax deductible maintenance/preservation contribution $40.00
The Vale Club newsletter is an electronic publication to save printing and mailing costs. If you are unable to receive the newsletter by email, please check here. _____
Please check here if wish to be contacted about placing an ad in the newsletter. _____
Please indicate any suggestions for speakers or activities for the next year: ______