Information
Name
Company
Address
Website
City
State
Zip Code
Phone
E-mail
Can we publish your name, address and phone # in the newsletter
Yes
Virginia Taxidermist Association
Membership Application
Membership
Individual - $50.00

Family - $75.00

Business - $105.00 - Includes business name on the VTA Website
Yes
No
No
Can we publish your name, address and phone # on the VTA Website
Please click "Send Details" When complete
Mail payment to:
VTA
Doris Viola
65 Beaver Lodge Road
Stafford, VA 22556
Date of Birth
Office Use Only

Member # __________
Check #____________
Check Date _________
Amount $___________
Office Use Only Member # __________ Check #____________ Check Date _________ Amount $___________