PVS-NCNW Membership Application

FOR NEW AND RENEWAL MEMBERSHIPS PROGRAM YEAR

POTOMAC VALLEY SECTION, NCNW, INC
MAIL-IN PAYMENT FORM

To be Financial during the 2025 - 2026 Program Year, dues are required by May 31, 2025 with a final deadline of September 30, 2025. (Note: This only applies to PVS Section dues.)

The National fiscal year runs from October 1 to September 30 each year.

Effective January 1, 2025, National dues are required for the upcoming 2025-2026 Program Year. Annual dues and membership fees, including per capita fees for Life and Legacy Life Members, will be due between January 1 and May 31 for the next fiscal year. Starting June 1, 2025 National late fee for Annual renewing members only is $10.00.
PERSONAL INFORMATION

ALL NEW AND RENEWAL MEMBERSHIPS PLEASE COMPLETE THIS SECTION IN ITS ENTIRETY (FOR RENEWAL MEMBERS THIS INFORMATION WILL BE USED TO VERIFY AND/OR UPDATE OUR RECORDS
TODAY's DATE

MonthDayYear
Date
FULL NAME*

First NameMiddle NameLast Name
MAILING ADDRESS (Street)*
APT. OR UNIT
CITY
STATE
ZIP CODE
HOME PHONE
CELL PHONE
EMAIL*
ex: myname@example.com
WHO REFERRED YOU
BIRTHDATE
MM/DD
WEDDING ANNIVERSARY
MM/DD
MEMBERSHIP TYPE AND DUES OWED
PROGRAM MEMBERSHIP YEAR DATE*
Select Membership Type

NEW MEMBERANNUAL RENEWAL MEMBERNCNW LIFE/LEGACY LIFE MEMBERNEW YOUTH MEMBERYOUTH MEMBER RENEWALSTUDENT/COLLEGIATE MEMBER
DUES OWED FOR NEW/RENEWING MEMBERSHIP (Select your Membership payment) *
For new members - PVS dues and national dues must be paid at time of joining. For annual renewal members – you have the option to pay national dues directly or include national dues with payment of PVS dues and the section will send to NCNW central office. If you are paying for more that one year, please indicate in Comment box.
Comments
If you are paying for more than one membership, list the members name and type of membership and select the various payment options. All new members need to complete a membership form.
NEW LIFE OR LEGACY LIFE MEMBERSHIP
NEW NCNW LIFE OR LEGACY LIFE MEMBERSHIPS CAN BE PAID IN A SINGLE PAYMENT OR 4 EQUAL AND CONSECUTIVE INSTALLMENTS. (Payment does not include PVS $25.00 Section dues).
Select Life Membership Option
Select Life Membership Payment Amount
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If you are not working on a PVS committee - Select below to Join A Committee(s)

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FOR NEW AND RENEWAL MEMBERSHIPS PROGRAM YEAR