Form

The Regency Society of Virginia / Membership Application
Membership Type:

Individual ($12 per Year) Family ($20 per Year) Youth Associate ($5 per Year)*
Founding Member: Please choose one of the membership types from above as well . You will only be charged the Founding member fee.

$30 one time fee, only offered in 2012
Full Name
First Name Last Name
Spouse's Name (for Family Membership)
First Name Last Name

Address

Phone Number
- Area Code Phone Number
E-mail
Children's Names - If Family Membership
Child's Name
First Name Last Name
Child's Name
First Name Last Name
Child's Name
First Name Last Name
Child's Name
First Name Last Name
Check here to exclude all information except for name(s) from lists distributed to the membership

Click Here
How did you hear about the RSV?
As an RSV member, what sort of time would you be willing to contribute?
*Youth Associate Applicants must have an RSV sponsor and permission from their legal guardian before their application will be considered. Please download the Youth Associate Sponsorship form from the website and return to an RSV officer at the next RSV meeting or event.
Membership Level - You will be directed to PayPal for payment
Individual $12.00 USD
Family $20.00 USD
Youth Associate $5.00 USD
Founding Member $30.00 USD
Should be Empty:

The Regency Society of Virginia / Membership Application