Membership in this Association shall be open to all ordained and/or ecclesiastically endorsed persons who are currently or have been previously employed as a chaplain in a healthcare within the Commonwealth of Virginia. Membership is also open to all ordained and/or ecclesiastically endorsed persons who are currently engaged in volunteer chaplaincy in a healthcare institution within the Commonwealth of Virginia.

____ Member Annual Dues: $25.00

Associate Membership in this Association shall be open to professional persons or students who do not meet the requirements for membership, but who indicate interest in the purposes of this Association. Applicants shall be admitted to Associate Membership following the receipt of a formal application, recommendation by the Membership committee, approval by the Association, and payment of current dues. Associate Members have all privileges of membership except the right to vote or hold an elective office.

____ Associate Member Annual Dues: $10.00

If this is a renewal only, fill out sections below where there are changes in information previously provided.

Mailing address:

_________________________________________________________

Business Phone (_____)__________ Fax: (_____)_________________

List this email address on the VCA website: Yes ___ No ___

Email Address: __________________________________________________

Current Position/Title: _____________________________________________ Full time ____ Part time ____ Volunteer ____

Print This Page and Mail Check And Completed Application To:

Chaplain Bette Goglia, BCC -- VCA Treasurer Mary Washington Home Health & Hospice

5012 Southpoint Parkway

Fredericksburg, VA 22407

Membership Fiscal Year Runs October 1 – September 30.