Academy on Violence and Abuse (AVA) : MEMBERS : Membership : New Membership

First Name (Required)

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Credentials (Required)

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Address Name (Required)

Address (Line 1) (Required)

Address (Line 2)

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Phone

E-mail Address (Required)

How did you hear about AVA

Have you already paid for and received your ACE DVD? (Required)

Membership Eligibility

By submitting this application, I verifty that I possess a current and valid professional license (if applicable), am in good standing in my other professional societies or organizations and am committed to the Academy’s Mission and Vision.

Membership Options

Payment Option

If you have already paid for your Membership, please select 'pay by check'

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Visa®, Mastercard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

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Click link below if you need a paper copy of the application.

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