AVANS 2026 IRC Membership Registration

AVANS 2026 IRC Membership Registration
Company Name*
First Name*
Last Name*
Mobile Number*
Company Email*
example@example.com
Title*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you served in the US Military*

N/AArmyAir ForceCoast GuardMarinesNavyPublic HealthOther
Do you have an Advanced medical Degree*
Membership Dues
Payment options

Pay by check or ACHPay by credit card (includes 3% service charge)
Membership Dues
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I am joining today for 2026 (Jan 1 to Dec 31)
$3,000.00 Quantity

Renewing my membership and pay my 2026 dues
$3,000.00 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00
Membership
Membership

I am joining today for 2026 (Jan 1 to Dec 31) ($3,000)I want to renew my membership and pay my 2026 dues ($3,000)
Procurement Contact (if applicable)

First NameLast Name
Procurement Email (if applicable)
example@example.com
To pay by check, please mail to the address below:

Association of VA Neurology Services

105 Cypress Meadows Drive

Wentzville, MO 63385

If you have any questions or concerns, please contact JoAnn Wahl at joann@avaho.org.
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Membership Dues