The Volunteer Center of the Lehigh Valley - 2008 Member Agency Registration Form

Agency Name: (must be 501c3 non-profit status)
Street Address:
City, State & Zip Code:
Volunteer Coordinator:
Volunteer Coordinator Email:
Volunteer Coordinator Phone #:	Fax #:
Agency Website:
Executive Director::
Executive Director Email:
Executive Director Phone #:
Agency Annual Budget:
Amount Enclosed:
If your organization's annual budget is: Your fee is: $0 - $100,000.................................$75 $100,001 - $500,000....................$125 $500,001 - 1,000,000...................$175 $1,000,001 + ................................$225 Membership Benefits Run January 1st to December 31st 2008 There is no pro-rated fee for partial year membership.
PRINT and then MAIL this completed form with CHECK made payable to: Volunteer Center of the Lehigh Valley 2121 City Line Rd., Bethlehem, PA 18017