Membership Form

Vigilant Torch Association Membership Application

Membership Option

Membership Levels and Cost

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work Phone

Were you referred by a current VTA member or do know a current VTA member?

If you answered "Yes" for the question above, please enter the name of the VTA member:

Help Us Cover Costs

Would you like to help cover processing costs?

Yes! I want $300.00 to go to Vigilant Torch and I will donate $309.00.No. I will donate $300.00 and Vigilant Torch will cover the processing costs.

Payment Information

Payment Options

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

AUTHORITY FOR RELEASE OF INFORMATION AND RECORDS

I consent to Vigilant Torch Association confirming my eligibility with the unit in which I served. The information will be used for the purpose of determining my qualifications for membership. I further certify that the execution of this form is voluntary and shall be valid for one year after my signing. I understand that the Vigilant Torch Association membership entitles me to the rights and privileges specified in the provisions of the Vigilant Torch Association By-Laws. Online payments will be paid to Vigilant Torch Association for either General or Associate Membership ($50.00) first years dues or Lifetime Membership ($300.00).

Fee structure is subject to change after annual review. Any member who has opted to pay life dues over an
extended period will not be subject to fee increases unless annual payment is not made.