THE NATIONAL ASSOCIATION
OF
THE VAN VALKENBURG FAMILY

NAVVF Membership Form

To become a new member or reinstate in the NAVVF, print and fill out the membership form below for each household. (You can also download the Acrobat version of this form to print.)

Please enclose a check payable to NAVVF, Inc. and mail to NAVVF Treasurer, at the address shown below.

If you have any questions regarding membership, please send e-mail to:

members@van-valkenburg.org

• Annual dues for regular members (18 years and older) are $8.50 each.
  

• Annual dues for junior members (under 18 years) are $2.00 each.

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MEMBERSHIP APPLICATION FORM

(Please show brithdate for any junior member on New or Reinstating blank)

Name______________________________New_____Reinstating_____

Name______________________________New_____Reinstating_____

Name______________________________New_____Reinstating_____

Name______________________________New_____Reinstating_____

Address______________________________________________________________

City/State/Province/Country___________________ ZIP (+4)____________________

Telephone (including Area Code) (____) ____________________________________

E-Mail Address_________________________

Amount enclosed: $___________

Make check payable to NAVVF, Inc. Mail to:

NAVVF Treasurer
Dalton Van Valkenburg
1230 Janet Avenue
North Canton, OH 44720-1839

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If any NEW MEMBERS are listed on the Membership Application Form, it would be helpful if the following information is provided for each new member so that we can place you in your NAVVF Branch.

Please copy this if there is more than one new member and provide this information for each.

List full names of parents, including mother's maiden name. Then list you Van Valkenburg(h) line grandparents, including your grandmother's maiden name.

New Member's Name____________________________________________________

New Member's Place of Birth_________________________________________________________________

New Member's Occupation________________________________________________

Father's Name _____________________________________________________
Place of Birth________________________________________________________

Mother's Name ____________________________________________________
Place of Birth ________________________________________________________

VV Line Grandfather's Name_________________________________________________________________

VV Line Grandfather's Place of Birth__________________________________________________________________

VV Line Grandmother's Name_________________________________________________________________

VV Line Grandmother's Place of Birth__________________________________________________________________

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