Membership Registration

 

Membership in the Miami Valley Venture Association is available to any person who qualifies as an investor, entrepreneur, service provider or investment organization. And now is the time to join!

Company Name
Company Representative
Company Representative #2
Company Representative #3
Company Representative #4
Company Representative #4
Address
City
State	Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
Zip Code
Phone
Fax
E-mail address

Type of Company

	Accounting		Law		Venture Capital		Manufacturing
	Academic		Financial		Research & Development		Technical Services
	Distribution		Retail

Other

COMMITTEES

I am interested in serving on the following committee:

Board Program Committee

Annual Membership Dues	(October 1 - September 30)
Individual Memberships	$210
Corporate Memberships	$300

Choose one
Individual Membership     Corporate Memberships

Note: The Association Administrator will mail you an invoice for annual dues, which will be due in 30 days

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The Miami Valley Venture Association
277 McDaniels Lane
Springboro, Ohio 45066
Phone: 937-212-0207
e-mail: jterrell@woh.rr.com