VRLA Membership Form

Name Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Home Phone Home Phone - ### - ### ####
Business/Daytime Phone Business/Daytime Phone - ### - ### ####
Business or Workplace Name
Primary Reporter Type *
Method of Reporting *
CCR/CDR Number *
CCR/CDR Year of Certification *
List any certifications received by national organizations
NCRA Certifications
NVRA Number (if applicable)
Special Interests and Skills

VRLA is in need of reporters who are willing to offer time and knowledge toward achieving goals and accomplishing tasks which further the court reporting profession state-wide. Please consider offering your name as a potential officer, committee chairperson, volunteer, etc.
Suggestions

Please provide suggested topics and/or speakers’ names for upcoming seminars
Comments or Questions
VRLA Annual Membership Fee $ Dollars . Cents