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Join, Renew, or Upgrade Your VTAF Membership

Please return this form and any attachments (Check? Matching Gift Form?) to:

VTAF Hokie Club

P. O. Box 10307

Blacksburg VA  24062

Name(s):_______________________________________

Address:_______________________________________

City:________________________  State:  ___________  Zip:  _________

Social Security Number:____________________________ (required)

Home Phone:  __________________  Work Phone:  _________________

E-mail:  ____________________________

Club Level Joining:  ___________________ (check our website)

Contribution Amount:  _________________

Referring Hokie Rep:    J. Rule (50 ZZ)  _________

(or choose your rep from our list)

For Charging to Your Credit Card:

Visa/Master Card Number:  __________________________ (for credit card only)

Expiration Date:  ___________________________________ (for credit card only)

Signature:  ________________________________________ (for credit card only)

Thanks for joining and.... GO HOKIES !!!!

This form is compliments of RoanokeValleyHokieClub.com

Updated 4/25/04