Become a Member
VSBN Membership Registration
 
Support VSBN's mission of promoting environmentally sound building practices and sustainable development for Virginia by becoming a member or renewing your membership for the Year 2012.

Use this form for mail registration or to pay by check. To register online through our secure server, please use our online form.
 
First Name   Required
Last Name   Required
Title 
Organization/Business   Required
Address (line 1)   Required
Address (line 2) 
City   Required
State   Required
ZIP Code (ZIP + 4)   Required
Country   Required
Email   Required
Phone   Required
Fax 
Website 
Please check box if this is a renewal   Yes, this is a renewal
VSBN Online Member Directory   Do not list my name on the VSBN Members page.
NEW! Capital Bikeshare Membership   Send me 2 Capitol Bikeshare free 24-hour
      memberships (available through Dec. 2012)


 Send me 4 Capitol Bikeshare free 24-hour
      memberships (available through Dec. 2012)
 
Please check all categories that best describe you and your company.
 Architect    Engineer    Builder    College    K-12 School    Consultant    Developer  
 Energy    Federal Gov.    State Gov.    Local Gov.    Non Profit Org    Waste     Financial  
Other 
 
Membership Type Annual Fee
Individual $50 
Non-profit and Government $75 
Small Business (Revenues under $500,000) $125 
Medium Business (Revenues between $500,000 - $5 million) $325 
Large Business (Revenues over $5 million) $675 
NEW! 25% discount when you enter your organization in the SMART Building Directory. $74 
Additional Donation $10   $25   $50 
  $100   $500   $1000 
 
Your total is:  $

 

 

PAYMENT OPTIONS

Please complete all payment information below.    Check Here if billing address is same as registration

First Name   Required
Last Name   Required
Organization/Company 
Billing Address   Required
Billing City   Required
Billing State   Required
Billing ZIP Code   Required
Billing Country   Required
Billing Email   Required
Billing Phone   Required
Card Type/Number      Required
Expiration Date      Required
3-Digit Card 
Verification Number 
 Required         What's This?

Select the Print button below to print a copy for your records, or to print and mail your registration form. If you register by mail and would like confirmation that your registration has been processed, please provide an email address.

         

If registering by mail, please print and complete this form, make checks payable to Virginia Sustainable Building Network, and send with your payment to:

     Virginia Sustainable Building Network
     Membership Form
     P.O. Box 6539
     Arlington, VA 22206

     Tel: (703) 486-2966

FOR OFFICE USE ONLY:
Rec'd _____________________ Ck# _______________ DataX _______________ DataACT _______________ TYL _______________ WS _______________
Note:
 
 
JAN12