DURHAM REGION ASSOCIATION FOR 

VOLUNTEER ADMINISTRATION

8 - 1288 Ritson Rd. N., Suite 329 Oshawa, Onatario L1 8B2

2012 ONLINE MEMBERSHIP APPLICATION FORM

*payment
information  
 

*Status

*Application For

annual membership $40.00
New Member Personal Membership Cheque Money order
Renewal

Agency Membership

Cash
        Membership and Conference ($140)

*Select One from each 

Make Cheque or Money Order payable to: Durham Region Association For Volunteer Administration
 

 AGENCY INFORMATION
    Agency Name
**Address

**City

**Postal Code

Executive Director
**Email
    Agency Website

Number Volunteers

Number of Hours

**Mandatory Information                        Phone number format      555-555-5555 

Representative Information
Representative's Name
Title
Email

Phone 

Fax 

Yes I agree to have my agency contact information distributed to DRAVA Members only.

Yes I give permission to DRAVA to use my photograph for the purpose of promotion.
Date (dd/mm/yy)