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Annual Dues Renewal To pay by phone call the VBA office at _804

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Annual Dues Renewal To pay by phone call the VBA office at _804 Powered By Docstoc
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                                                                                                      701 East Franklin Street, Suite 1120
                                                                                                               Richmond, Virginia 23219
                                                                                                    (804) 644-0041 • Fax (804) 644-0052
                                                                                                                      Web: www.vba.org
                                                    Annual Dues Renewal                                          E-mail: thevba@vba.org


Name: ________________________________
                                                                         Enter Total Due Shown on
Member ID Number: ____________________                                   Your Annual Statement:                            $ ____________

Please make address corrections below:

Firm: __________________________________________

Address: _______________________________________                                          To pay by phone
             _______________________________________
                                                                                         call the VBA office
                                                                                          at (804) 644-0041.
City, State, Zip: _________________________________

Phone: (        ) _____________ Fax: (                 ) _____________

E-mail Address: _________________________________


Also, I would like to add the following sections to my membership:

Administrative Law . . . . . . . . . . . . . . . . . . . $25 -           Health Law . . . . . . . . . . . . . . . . . . . . . . . . . . $25 -
Bankruptcy Law. . . . . . . . . . . . . . . . . . . . . . $25 -          Intellectual Prop. & Info. Technology Law. . . $25 -
Business Law . . . . . . . . . . . . . . . . . . . . . . . . $25 -       Judicial Section (For Judges Only) . . . . . . . $25 -
Civil Litigation . . . . . . . . . . . . . . . . . . . . . . . $25 -     Labor Relations and Employment Law . . . . $25 -
Construction and Public Contracts Law . . . . $25 -                      Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . $25 -
Corporate Counsel . . . . . . . . . . . . . . . . . . . . $25 -          Taxation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $25 -
Criminal Law . . . . . . . . . . . . . . . . . . . . . . . . $25 -       Transportation . . . . . . . . . . . . . . . . . . . . . . . . $25 -
Domestic Relations . . . . . . . . . . . . . . . . . . . . $25 -         Wills, Trusts & Estates . . . . . . . . . . . . . . . . . $25 -
Elder Law . . . . . . . . . . . . . . . . . . . . . . . . . . . $25 -    Va. Alternative Dispute Resolution, Jt. Cmte. . $25 -
Environ., Natural Resources & Energy Law . $25 -
                                                                                              0.00
                                                                         Total Section Dues $ ___________

VBA Foundation Patron Contributions (Elective)                                               0.00
                                                                         TOTAL AMOUNT DUE $ ___________
Leadership Patron (Gold) $500 and above -                                Please charge my credit card.
Sustaining Patron (Silver) $250-499 -                                    Check one: - VISA - MasterCard - AMEX
Patron (Blue) $100-249 -

Total Patron Contributions $ ___________                                 Card # ________________________
                                                                         Exp. Date _____________________


Applicant’s Signature __________________________________                          Date __________________________

				
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posted:10/1/2011
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