Membership application form - SEVA ATD



SouthEastern Virgina Association of Talent Development Membership ApplicationApplicant Information- USE ChIP Code 4096Name: Email: Company : Job Title: Phone:Current address:City:State:ZIP Code:New Renewal (Please circle)Chapter Code: SEVA4096National Membership #: Annual Membership Level : Circle or highlight one Professional: $65 (Any professional member that is not classified as a student, military or corporate level status.)Active/Transitioning Military Professional: $50 (Beginning April 1, 2016 all active duty military professionals will need to verify their military status via the Director of Membership. Transitioning military professionals are defined as a military professional that has transitioned six months to a year from the military. Please include your branch of service. Once you have been verified you can hold this membership for two years from transition and then will be converted to a professional member. Active Duty members will continue to be verified by the Director of Membership.)Student: $35 (Beginning April 1st, 2016 all student memberships will be verified by the Director of Membership before approval. Once approval has been made the Director of Membership will activate the student accordingly. Student Membership must include a current .edu email address to secure this membership. Students can hold this membership level for three years from the start of their membership with SEVA ATD. Once the three years has lasped the student should consider membership as a professional member. ***Current Transcripts may be required****Corporate Membership Tier 1: (Tier 1 allows a company to identify 5 to 15 employees as members of SEVA at a cost of $50 per member. Discount code assigned by SEVA ATD Site Administrator. Administrators must enroll at least five members to activate the corporate membership level each year. Failure to activate five members each year will place each member in the professional member level status.)Corporate Sponsor Member: By invitation only. Allows a chapter sponsor to add up to 20 employees as members of SEVA at a cost of $35 per member. Discount code assigned by SEVA ATD Site Administrator.Corporate Senior Member: This membership level is available for individuals ages 65 and older. ID verification will be required. Payment Information Check/Money Order: Visa: Card # Exp Date/Security Code: Master Card: Card # Exp Date/Security Code: Discover Card #Exp Date/Security Code: Signature:Date:Name on Card: Signature:Date:Name on Card:Signature:Date:Name on Card:Billing Address Company:Employer address:How long?Phone:E-mail:Fax:City:State:ZIP Code:Payment OptionsMail to: Attention- SEVA ATD Membership Email: Phone: P.O. Box 62125membership.sevaatd@757-563-3690Virginia Beach, VA 23466Attention: Membership Payment SignaturesI authorize the verification of the information provided on this form as to my credit and employment. I have received a copy of this application.Signature of applicant:Date:Signature of spouse (only if for a joint membership):Date: ................
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