Membership Form

Please complete the following information regarding 26 - 27 CIAVA membership. Once you click "Submit", you will be re-directed to the dues payment page. Please note your membership will not be complete until payment is received.

26-27 Membership Dues

Standard Membership | Dues: $175
Organizational Membership | Dues: $425

Unlimited staff of the same organization

Member Information

* Indicates required field

Name *

First

Last

Title *

Organization Name *

Do you have your CVA? *

Contact Information

Email *

Preferred Phone *

Membership Type & Payment

Type *

How will you pay dues? *

For organizational Membership

(Skip if applying for any Standard Membership.)

Please list the names, titles, and email addresses of all other staff members using the CIAVA benefits.

Additional Staff Member #1

Name *

First

Last

Job Title *

Email *

Additional Staff Member #2

Name *

First

Last

Job Title *

Email *

Additional Staff Member #3

Name *

First

Last

Job Title *

Email *

release

This Release ("Release") is executed in favor of Central Indiana Association of Volunteer Administration and each and all of its directors, officers, agents, and representatives (collectively, "CIAVA"). I hereby freely and voluntarily execute this Release and agree to the following terms and conditions as a member of the association:

MEDIA RELEASE: I grant CIAVA permission to use my name, image, voice, appearance, and likeness for stories or advertisements that may be solicited on its behalf. This may include, but is not limited to, print advertising, photographs, public service announcements, promotional materials, video or audio recordings, news reports, etc. I understand I will not be eligible for any compensation related to the production and use of my name, image, voice, appearance, or likeness in any advertising or promotional materials and other media coverage as set forth herein.

By clicking the submit button below labeled you:

(1) Acknowledge that you have read and understand the Terms detailed above;
(2) Acknowledge that your membership status will remain inactive until payment is received in full;
(3) Are signing this agreement using your electronic signature.
Under federal law, an electronic signature like this one is just as binding as manually signing a paper document.

Submit

Membership Form

Member Information

Contact Information

Membership Type & Payment

For organizational Membership

release

Services

Address