VCOA Membership Fax Form

ADDRESS INFO
Membership Type: Circle or tick the appropriate membership	VCOA Membership (US) ($35.00) One year's membership to the Volvo Club of America (VCOA) for American members. VCOA Membership (Canada) ($40.00) One year's membership to the Volvo Club of America for Canadian members. VCOA Membership (International) ($50.00) One year's membership to the Volvo Club of America for International members.
Number of Additional Associate Members ($5.00 per year each):	_____
Names of Additional Associate Members:	________________________ ________________________ ________________________ ________________________
Your Full Name:	____________________________________
Your E-Mail Address:	____________________________________
Your Phone Number:	____________________________________
Your Fax Number:	____________________________________
Street :	____________________________________
City :	____________________________________
State :	____________________________________
ZIP :	____________________________________
Country :	____________________________________
RENEWAL?
Is this membership a renewal of your existing membership?	YES NO
If YES, what's your members number?
CREDIT CARD INFO
Name on the Card:	____________________________________
Credit Card Number:	____________________________________
Expiry Date:	____________________________________
CVS Number :	____________________________________( 3 digits on back of card near the signing area)
VOLVO(S) OWNED
Volvo(s) Owned Enter the year and model of each Volvo you own, one per line.	____________________________________ ____________________________________ ____________________________________ ____________________________________
ADDRESS INFO (if different from above)
Street :	____________________________________
City :	____________________________________
State :	____________________________________
ZIP :	____________________________________
Country :	____________________________________

Please print off this form and fax it to (607) 639-2280