New England Virtual Assistants Membership Application

Membership Application
Type of Membership:	Associate Membership (* fields are required)
Please fill in your info:
*Name:
*Business Name
Address:
City:
State:
Zip:
*E-mail Address:
*Business Phone:
Cell Phone:
*Website:

Please list your services as you would like them listed on our website:

Do you know any of our members?	Yes No If yes, please list the member(s):

*What would you like to gain from NEVA?
*How could your business benefit Virtual Assistants?
Would you be willing to offer any of the following: (please check all that apply)	Speak at Luncheon Speak during Conference Call	Discounts to Members Door Prizes at Conferences
	Write Guest Articles for Newsletter
How did you hear about NEVA?
Upon acceptance to NEVA you will be billed for $100 for the Associate Membership. Once payment is received you will become eligible for all member benefits at your level. I would like to be invoiced pay through Intuit Payment Network (similar to PayPal but less hassle)