2008 VAAOM Membership Form

This form may be printed before or after filling it out, or you may fill it out and submit it electronically.

Practioner info:	Please note: These first 4 items are required info. Thanks. First Name: Last Name: E-mail : Is this a renewal? Yes No If "No", or if you're renewing but have changes to make in your info, please fill out the rest of this form

2008 Membership Fee – $60 (payable to VAAOM)

An electronic submittal of this form will send your info to us, and then take you to our payment page, where you can pay for your membership online with a credit card or paypal balance. If you would prefer to send a check, please print this form and mail it with your check to:

VAAOM - Membership
PO Box 337
Williston, VT 05495

all comments and queries can be directed towards

webminister@vaaom.org

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