Join the Viper Owners Association

All memberships will include membership badge(s), VOA decal, and free gift of a VOA microfiber polishing cloth (for glasses/phone/tablet). Please fill out the fields below. Charges to your card will be made once you submit your registration.

* indicates a required field

Personal Information

Salutation:

*First Name:

Middle Name:

*Last Name:

Suffix:

Address Information

*Country:

*Street Address:

Line 2:

*City:

*State:

*Postal Code:

Contact Information

Home Phone:

*Cellular Phone:

Office Phone:

Fax:

*Email:

Second Badge Email:

Viper Information

Please only list cars you still currently own

Viper #1

*Year:

*Model:

*Color:

*VIN:

Viper #2

Year:

Model:

Color:

VIN:

Viper #3

Year:

Model:

Color:

VIN:

Additional Badges

	Salutation:	First Name:	Middle Name:	Last Name:	Suffix:
Second:
Third:						+$5.00
Fourth:						+$5.00

Membership Information

Level:

Click Here for a map of VOA regions to help you choose your local club affiliation

Region:

Custom Member #: (you may choose your own member number if it's available, otherwise you will be assigned a number)

Referral Information

If you were referred to the club by a current member, please let us know who it was. For every new member referral, we offer a $25 gift card to the VOA Store to the person who referred you!

Referred by:

Additional Merchandise

VOA Polishing Cloth: +2.00 ea

VOA Neck Lanyard (for name badge/credentials): +3.00 ea

VOA Lapel Pin: +4.00 ea

VOA Mouse Pad: +5.00 ea

VOA Club Pen: +5.00 ea

VOA Viper Keychain: +5.00 ea

VOA Windshield Banner (4.75"x12.75"): +10.00 ea

Extra Membership Car Decal (3.5"x3.5"): +2.00 ea

VOA Club Sticker: +2.00 ea

VOA USB Car Charger: +8.00 ea

copy from above

*First Name on Card:

*Last Name on Card:

*Billing Street Address:

*Billing City:

*Billing State/Province:

*Billing Postal Code:

*Card Type:

*Card Number:

*Expiration date:

*CVV2: What is this?

By paying via check, we are allowing you the opportunity to secure a member number and join without having to pay immediately. This reservation will be valid for 14 days, and will be automatically purged if payment is not received by the end of the 14 days.

Check this box to pay via check:

You may submit payment in the amount shown below to:

Viper Owners Association
ATTN: Membership Dues
PO Box 585
London, Ohio 43140

Total:

All memberships run on a calendar year basis. For that reason, your membership will be prorated (quarterly) based on when you join, and it will expire at the end of the calendar year. The quarters are synced with our magazine subscription so you will not miss an issue.
4th Quarter (October to December includes the following year) - $115.00 / $150.00
3rd Quarter (July to September) - $75.00 / $95.00
2nd Quarter (April to June) - $95.00 / $125.00
1st Quarter (January to March) - $115.00 / $150.00

Agreement

Membership Liability Waiver and Acknowledgment In consideration of the VOA granting me, club membership, I, by execution and/or receipt of this membership form, or by my signature below, or by my verbal acknowledgment of the receipt of this application/Notice, or by my payment of my membership fee by any method, hereby release and discharge the Viper Owners Association and its Regions, officers, agents, members, representatives, and all other persons or Agencies affiliated with this Club from any and all known and unknown damages, injuries, judgments, and/or claims from any cause whatsoever that may be suffered by me or any member to his/her person, family or property and related to my membership or participation in the Viper Owners Association. Liability insurance is for VOA social activities only, and does not include any racing, track, or competitive driving events. I acknowledge that Membership is limited to current owners of a Viper and affirm that as of the date of this application I currently own the Viper(s) listed herein. I further acknowledge that Active Members must be an individual at least 18 years old and affirm that I satisfy that requirement. I further expressly agree to abide by all VOA bylaws, Procedures and Policies as established by the National Board and the Board of Directors (VOA Regional Presidents) or its designees, and by my payment of my membership fee, expressly acknowledge my awareness and acceptance of all such governing principles, inclusive of this waiver and acknowledgment.

I agree to the rules of the Viper Owners Association: Yes No

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