NLVA Registration


Please complete ALL fields of the following form. Once you click "SUBMIT FORM" at the bottom of the page, your application will be reviewed by the NLVA.

If you have any questions, please feel free to contact the NLVA at (709) 576-0817 or through email at nlvaruss@sportnl.ca.


2013-2014
NLVA Annual Membership
$10
 
Role with NLVA:
 
NLVA Membership Number#:
 
Name:
Date of Birth:
Email:
Address
Regional Zone:
Western
Central
Eastern
Avalon
Labrador
Northern
 
 
Emergency Contact Info

(Name, Home# Cell#)

Method of Fee Payment:
PayPal (Credit Card Online)
Cheque/Money Order in Mail