MEMBERSHIP APPLICATION and DONATIONS

View Membership Rights and Privileges here.

You may either print this application and mail it in with your check, or you may send it by email and pay your dues with your credit card immediately. First, fill out this application online. At the bottom, if you wish to print it, click the PRINT. If you wish to send it by email and pay with your credit card, click the SUBMIT link. If you wish to do both, that is, print it and also pay by credit card, first click the PRINT link, then click the SUBMIT link afterwards.

Year First Joined: New Member Renewal

Name:

Address:

City: State: Zip:

Home Phone: Fax: E-mail:

To make a DONATION only, click here.

Business

Business Name:

Work Phone: Cell: E-mail:

Membership

Regular Member	Dues $10.00 Any legally blind person who manages or is an employee in a facility.
Associate Member	Dues $10.00 Any Interested person, business or organization wishing to support the aims and goals of R.S.V.A.
Life Member	Free, retired, 5year-member nominated by state affiliate or any member in good standing wishing to become a Life member for a one time donation of $200.00.
Life Member in President's Council	Or any member in good standing wishing to become a Life member in the President's Council for a one time donation of $1000.00. This member will receive a plaque and special recognition at a national convention and in the Vendorscope.
Corporate Member	Any business or organization wishing to support the goals of R.S.V.A. Please contact the national office for details.

Member Profile

Vendor Administrator Spouse Employee Other
Other:

Blind Partial Sighted

Gender
Female I Identify as a Female Male I Identify as a Male Nonbinary Other - I prefer not to answer

Race/ethnicity
Asian Black or African American Hispanic or Latino Middle Eastern or North African
Multiracial or Multiethnic Native American or Alaska Native South Asian White Anglo/Caucasian Other

Vendorscope

Large Print Duplicate CD E-mail

ACB Braille Forum

Large Print Braille Digital Cartridge

Donations

Before making a donation, please verify your name and address info is complete at the top of this page.

Randolph-Sheppard Vendors of America:

Durward K. McDaniel Memorial Fund (A legacy of legal support):

You will be able to pay by Credit Card on your PayPal account after you submit your registration form.

CAUTION! The membership application is a two-step process. Fill out the form and send in the payment. The process is not complete until both steps are finished.

Click the below SUBMIT button and Pay

If making payment by check, make check payable to R.S.V.A. Treasurer
and mail check to:
Terry Camardelle, Treasurer
940 Parc Helene Drive
Marrero, LA 70072-2421
Phone: 1-504-328-6373

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Randolph Sheppard Vendors of America^®
940 Parc Helene Drive Marrero, LA 70072
Email: rsva@randolph-sheppard.org Website: www.randolph-sheppard.org