MEMBERSHIP APPLICATION
Print, complete and return with dues payment to:
Virginia Aquaculture Association • P. O. Box 115 • Bremo Bluff, Virginia 23022

TO PAY BY CREDIT CARD: Check "Bill Me via PayPal" and mail completed application.
You must have an active e-mail address for us to bill you via PayPal.
Upon receipt of application, we will e-mail an invoice for you to pay online via PayPal.
___ Check Enclosed                          ___ BILL ME via PayPal

___ SPONSOR $150: Any person, firm, or organization that meets the qualifications of a producer member or associate member that would like to extend their membership contribution to include additional funds to support the activities of the VAA. Benefits include a listing on VAA print communications and on VAA website with link. ONE vote.

___ PRODUCER $30: Any person, firm, or organization engaged in culturing, growing, processing and/or selling aquaculture products, actively, or in transition, in the state of Virginia. ONE vote.

___ EDUCATOR (Middle/High School level only) FREE: Any secondary school educator with an aquaculture program in the classroom, or who has plans to develop an aquaculture program in the near future. ONE (Associate) vote.

Are you in production now? ___ Yes ___ No. If yes, list species(s):________________________________________

_______________________________________________________________________________________________

Selling? __ Yes __ No.           If yes, check all that apply: _____ Retail _____ Wholesale _____ Direct to Consumer

Growing system(s) used: (cages, tanks, etc.)__________________________________________________________

Aquaculture related interests and/or services or products offered _________________________________________________________________________________________________

________________________________________________________________________________________________

Name _____________________________________________________ Title __________________________________

Farm/Company/Organization/School __________________________________________________________________

Address _____________________________________________________COUNTY ____________________________

City/State/Zip _____________________________________________________________________________________

Home Phone _____________________________________ Work Phone _____________________________________

Fax ___________________________ E-mail ____________________________________________________________

Website Address _________________________________________________ Best time to call __________________