VAOT Membership Form

2010 Annual Dues

 Membership 2010          Renewal / New Member

Name:______________________________________

Address:____________________________________

 City:_________________   State:____ Zip code:____

Home Telephone Number:______________________                                                                                   
Employer Name_______________________________

Employer Address_____________________________

Work Telephone Number:________________________
                                                                         
E-mail Address:_______________________________   

Amount Enclosed:_____________________________

Make checks payable to VAOT           $25.00 annual dues

Send forms to :

Sharon Peters RTR/OTC

869 Ross Rd.

Lexington, VA  24450