Name ___________________________________________________________
Spouse ___________________________________________________________
Children ___________________________________________________________
___________________________________________________________
Address ___________________________________________________________
___________________________________________________________
Phone ________________________ E-mail ________________________
Member Non-member # of People Fee Adult $20.00 $25.00 ________ ________________ Child (3-12 years) $15.00 $20.00 ________ ________________ Children (below 3 years) Free Free Donation (any amount) ________________ Membership Fee ________________ Total ________________Please mail this completed registration form along with your fee (payable to VPA-EAST), by August 1, 2001 to :