Membership Form

Payment can be made via PayPal or by check payable to AzSVAH. Mail to
Sherry Roueche
AzSVAH Treasurer

26417 N 49th Lane, Phoenix, AZ 85083

Name:

Title:

Facility:

Type of Facility: (hospital, rehab center, etc)

Address:

City:

AZ, Zip:

Business Phone:

Cell Phone:

Email:

May we share your contact information with other members?

Yes No

Number of Volunteers:

Number Hospital Beds:

First year employed as Volunteer Administrator:

First year employed at current facility:

Please list your other professional organization memberships and certifications:

Are you joining today in conjunction with the 2024 conference registration?

Yes No

Membership Options – choose one:

Full
Must be employed or recognized by the administration of a health care institution, have as their major responsibility the volunteer services program, and are responsible to an administrative staff member of the institution.

Associate
With the approval of the Executive Committee, persons who are concerned with the management of volunteer services, and who are with an organization in the health field that is not a health care facility.

Retired
Persons holding either full membership or associate membership may, upon retirement, be eligible for Retired membership.

Consultant
With the approval of the Executive Committee, Consultant membership may be granted to persons who provide consultation and/or training in management areas of interest to the membership.

Student
Full time or part time college student