PVAAC Member Application / Renewal / Donation

PVAAC is inclusive. You are not required to be a Member to participate in anything. However, we appreciate your support as a Member and Active Members save money, so your membership is a win-win!

Individual Member $30

Amounts below include one Basic Membership plus the additional donation per member required for that level.

Silver Member                $50-$129
Gold Member                $130-$199
Emerald Member          $200-$399
Platinum Member         $400-$799

Diamond Member         $800-$999
Ruby Member            $1000-$1499
Hallmar Member       $1500-$2999
Ultra Hallmark Member    $3000 +

Please note: Completing this form will help us serve you better, plus help us continue to qualify for funding so we can maintain our meal and vital services at as low cost to you as possible. This information will be kept confidential. Thank you.

Please fill out this form, or download a printout to bring to our office. At this time, we are experiencing technical difficulties with PayPal. Please bring in your donations or membership dues by credit card (can also be done by phone), cash, or check. We apologize for the inconvenience.

PVAAC Form Membership / Renewal / Donation

Membership Donation
Membership
Amounts below include one Basic Membership plus the additional donation per member required for that level.
Choose Membership/Sponsorship Type
Person 1
Person 1
First
Last
Person 2
Person 2
First
Last
Mailing Address
Mailing Address
City
State
Zip/Postal
Please indicate how many months you plan to live at this address so we can send your mail to the appropriate location.
Disability (1)
Disability (2)