Name ___________________________________________________________
Spouse ___________________________________________________________
Children ___________________________________________________________
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Address ___________________________________________________________
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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 :