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Company name*

CEO/Director First name*

CEO/Director Last name*

Job title*

Work Email*

Mobile phone number

Direct Line

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Organizational Mailing Address*

Mailing Address 2

City*

State/Region*

Postal code*

Organization Type*

Website URL*

EIN or BN Number*

Annual Total Operating Expenses*

Line 18 on Tax Form 990, no commas or decimals

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Dues are based on your total operating expenses entered above.

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Become a VSA MemberRequest an Invoice