OCVA Membership Form

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OCVA Membership Form
Membership level:
  $ 10.00   Low income
  $ 25.00   Basic membership
  $ 40.00   Contributing member
  $100.00   Organization member
Additional donation:  $
Name:
Organization:
Address:
City:
State: Zip: -
Primary
Phone:
Alternate
Phone:
FAX:
E-mail:
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Please send the completed form with your check (payable to OCVA) to:

OCVA
P.O. Box 1388
North Plains, OR  97133-1388

Thanks for your support!

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