Central Virginia Iranian American Society

(www.RichmondIranians.com)

 

Membership Form

 

Please send the completed form and payment to:

CVIAS

12417 Lynwood Drive

Glen Allen, VA 23059

Member Information: Please type or write legibly.

 

Annual membership due is $15 per person.

Central Virginia residents 18 years and older may join CVIAS.

First Name

 

Last Name

 

Mailing Address

 

Phone Number

 

Email Address[1]

 

Preferred Communication Method (circle one):

 

             Email1         Phone         Regular Mail

Member Signature &

Date:

 

New Member/Renewal

New Member ___       Renewal ___

Office Use Only:

Membership dues received by (treasurer):

<Sign and Date>

Member information recorded and filed by (secretary):

<Sign and Date>

Membership Cancellation

<provide reasons and effective date of cancellation>

 

 

 

<President: Sign and date>            <Secretary: Sign and Date>

 


1. Email is an effective and inexpensive communication tool. It allows CVIAS to send out timely notifications about the upcoming events and other information. Your email address will not be given out to anyone outside CVIAS.