MEMBERSHIP APPLICATION

TO APPLY FOR MEMBERSHIP IN YOUR AREA PLEASE VISIT REGIONAL CHAPTERS. MEMBERSHIP ENTITLES PARTICIPATION WITH OTHER CHAPTERS, A QUARTERLY NEWSLETTER AND DAILY UPDATES ON VOSH.ORG.

IF THERE IS NO CHAPTER IN YOUR REGION PLEASE SEND THIS FORM AND DUES OF $40.00 TO VOSH/INTERNATIONAL TO BECOME A MEMBER-AT-LARGE. IF YOU WOULD LIKE TO START A STATE CHAPTER VISIT HOW TO FORM A CHAPTER OR CONTACT DR. DAVE MCPHILLIPS.

I WISH TO JOIN VOSH/INTERNATIONAL TO FACILITATE THE PROVISION OF VISION CARE WHERE IT IS NOT AFFORDABLE OR AVAILABLE.

NAME_______________________________________________________________________________

ADDRESS____________________________________________________________________________

OCCUPATION: ________________________________

HOME TELEPHONE: ___________________ OFFICE TELEPHONE: _____________________

I AM INTERESTED IN PARTICIPATING IN A VOSH MISSION (    ) (check box if interested)
I UNDERSTAND THAT ANY PARTICIPATION IN A VOSH MISSION IS AT MY OWN RISK.
 
VOSH/INTERNATIONAL IS A 501 ( C ) ( 3 ) TAX EXEMPT HUMANITARIAN ORGANIZATION.
(MANY BUT NOT ALL  CHAPTERS HAVE THEIR OWN TAX EXEMPT STATUS)

ANNUAL DUES OF $40.00 IS A TAX DEDUCTIBLE DONATION THAT WILL HELP US IN OUR MISSION TO PROVIDE VISION CARE WORLDWIDE TO THOSE WHO CAN NEITHER AFFORD NOR OBTAIN SUCH CARE.

PRINT AND MAIL TO:

MY TAX DEDUCTIBLE DONATION IN THE AMOUNT OF $ __________ IS ENCLOSED
For your convenience, you may pay your dues and make donations by using your credit card and clicking on the button below.
THANK YOU.

SIGNATURE___________________________________________________DATE_____________________