IFVP Membership Form …

                                  IFVP Membership Form
                                  CONTACT INFORMAT ION:
                                               Name
                                           Company
                                             Address
PAYMENT OPTIONS:                                  City                                   State
Pay by Check or Money
                                    Zip/Postal Code                                   Country
Order, Send by Mail:
Please send this completed                      Email
form and a check or money
order for complete costs to:         Primary Phone                                   Home        Work      Cell
      IFVP
      Box 4192                    MEMBERSHIP INFORMATION:
      Washington, PA               New member     Renewing IFVP member
      15301
Please make payment to            PAYMENT INFORMATION:
"IFVP."                            I would like to begin/renew my membership for:
You will receive email
confirmation of your                    I would like to purchase a ONE YEAR membership in IFVP,          $100
registration.                           including my own webpage on the official IFVP website, $125
                                        discount on attendance at the annual conference, and
Pay by Credit Card,Send                 eligibility for free Associate Membership in Fractured Atlas.
by Fax:                                 I would like to purchase a TWO YEAR membership in IFVP,          $185
Please fax this completed form          including webpage, conference discount, and FA Associate
to:                                     eligibility.
        724-228-5888                    I would like to purchase a THREE YEAR membership in              $275
                                        IFVP, including webpage, conference discount, and FA
You will receive a Paypal               Associate eligibility.
invoice for complete costs plus
a 3% credit card processing             I am a student, and I would like to purchase a one-year          $75
surcharge via email. After we           membership at the student rate (includes posting on student
receive your payment, we will           showcase webpage). Must include copy of current student I.D.
email confirmation of your
registration.                           I would like to make a donation to the IFVP scholarship fund.

                                                                                       TOTAL COST:


                                  PAYMENT METHOD: (Please see left for details)
                                    Check/Money Order via Mail               Credit Card via Fax

                                  Thank you for your membership in the International Forum of Visual
                                  Practitioners. You will receive an email confirmation of your membership and
                                  information on how to build a Directory page at IFVP.org within two weeks.