Name ___________________________________________________________
Spouse ___________________________________________________________
Children ___________________________________________________________
___________________________________________________________
Address ___________________________________________________________
___________________________________________________________
Phone ________________________ E-mail ________________________
Member Non-member # of People Fee
Adult $15.00 $20.00 ________ ________________
Child (3-12 years) $10.00 $15.00 ________ ________________
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 March 17, 2001 to :