EmailMe Form - KVA-AVCA Signature Affiliate Membership

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New Membership

Membership Renewal

Name *

First Last

Coaching Title *

Email Address *

School/Organization *

School Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Mobile Phone

### - ### - ####

Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Please mail my publications to: *

School Address

Home Address

(Includes KVA membership & AVCA HS/Interscholastic Membership) *

High School/Interscholastic Membership - $95.00

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PAY BY CHECK (Payable to "AVCA"; Mail to: AVCA, 2365 Harrodsburg Rd, Suite A325, Lexington KY 40504-reCAPTCHA-CLICK SUBMIT)

PAY BY CREDIT CARD (Input CC information below-reCAPTCHA-CLICK SUBMIT)

If Paying by Credit Card; What Type of Card?

VISA

MASTERCARD

AMEX

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