Virginia Benefit Programs Organization Membership Application Each Membership Year begins on July 1st and ends on June 30th Date: 6/5/2018 (defaults to current date when printed) Annual dues: Individual*/Associate Membership**: $30.00 + Mail your application & check (payable to BPRO) to: Please remit by no later than August 31st Virginia Benefit Programs Organization P O Box 731 (First-time individual memberships are half-price Front Royal, Virginia 22630 after December 31st ) DO NOT SUBMIT THIS EMAIL Tab to each question, type in the DO NOT USE THIS FORM WHEN PAYING ONLINE information, and print a copy to be returned along with your dues Check below, as Check below, as Check below, as applicable: applicable: applicable: Personal payment Individual Renewing/existing Member enclosed Membership* First-time Member Agency’s payment Associate Returning/former Member enclosed Membership** Name Agency Agency FIPS Code Planning District (PD) Phone Number Fax Number Email Address Check the specific program(s) for which you are responsible: Auxiliary Grant Fraud Medicaid TANF Energy Assistance General Relief VIEW Foster Care & Adoption Assistance Check the committee(s) on which you would like to serve: Archives Foster Care & Legislative TANF/VIEW Bylaws/Policies & Adoption Assistance Medicaid/AG VaCMS/Technology Procedures Fraud Professional Communication Fundraising/Awards Development Energy Assistance Hospitality Your State Legislative Information: Don’t know how to answer? Senate District Number: Visit My Legislator?” at “Who’s House of Delegates District Number: (This address is also available on our page) “Directory” * Any person employed by a local, regional or state Department of Social Services office, who is directly or indirectly responsible for eligibility determination or for the administration of eligibility programs, shall be eligible for Individual Membership. ** Any person who does not currently function in the determination or administration of eligibility programs in local social service agency, but who has an interest in the purposes and activities of this organization, shall be eligible for Associate Membership. At no time shall associate membership exceed twenty-five percent (25%) of the total membership.
Virginia Benefit Programs Organization Membership Application Each Membership Year begins on July 1st and ends on June 30th Date: 6/5/2018 (defaults to current date when printed) Annual dues: Individual*/Associate Membership**: $30.00 + Please remit by no later than August 31st (First-time individual memberships are half-price after December 31st ) Mail your application & check (payable to BPRO) to: Virginia Benefit Programs Organization P O Box 731 Front Royal, Virginia 22630 DO NOT SUBMIT THIS EMAIL DO NOT USE THIS FORM WHEN PAYING ONLINE Tab to each question, type in the information, and print a copy to be returned along with your dues Check below, as applicable: Personal payment enclosed Agency’s payment enclosed Check below, as applicable: Individual Membership* Associate Membership** Check below, as applicable: Renewing/existing Member First-time Member Returning/former Member Name Agency Agency FIPS Code Planning District (PD) Phone Number Fax Number Email Address Check the specific program(s) for which you are responsible: Auxiliary Grant Energy Assistance Foster Care & Adoption Assistance Fraud General Relief Medicaid TANF VIEW Check the committee(s) on which you would like to serve: Archives Bylaws/Policies & Procedures Communication Energy Assistance Foster Care & Adoption Assistance Fraud Fundraising/Awards Hospitality Legislative Medicaid/AG Professional Development TANF/VIEW VaCMS/Technology Your State Legislative Information: Senate District Number: House of Delegates District Number: Don’t know how to answer? Visit “Who’s My Legislator?” at (This address is also available on our “Directory” page) * Any person employed by a local, regional or state Department of Social Services office, who is directly or indirectly responsible for eligibility determination or for the administration of eligibility programs, shall be eligible for Individual Membership. ** Any person who does not currently function in the determination or administration of eligibility programs in local social service agency, but who has an interest in the purposes and activities of this organization, shall be eligible for Associate Membership. At no time shall associate membership exceed twenty-five percent (25%) of the total membership.
2018-2019_membership_application.docx