Association of VA Audiologists
Contributing Member Voluntary Dues - Membership Year 2009
October 1, 2008 through September 30, 2009
Last Name*: First Name*:
Station: VISN:
Mailing Address: Street:*
City:* State:* Zipcode*:
Home Phone:
Office Phone:
Home e-mail*:
Office e-mail:
*denotes mandatory fields for processing
After completing, please print this page and send it with a check for $45.00 payable to CHEP to:
Please included a SASE so an AVAA Contributing Member Membership card and receipt can be sent.
The AVAA, as an organization under the umbrella of the AFASLP, is recognized by the IRS as a 501(c)6 organization. Voluntary dues payments are not deductible as charitable contributions. They may be deductible as a business expense. Please consult your tax advisor for further information.