VB ASSOCIATION MEMBERSHIP APPLICATION FORM 2017-2018

Voluntary Benefits Association (VBA)
Please complete this form for submission to VB Association
Mail: 4371 Northlake Blvd., Suite 331
Palm Beach Gardens, FL 33410
Telephone: 561 790-1176 ext. 809
Fax to: 866.547.1639
E-mail: info@vbassociation.com

Company / Member's Information
Contact Person's Information

Please enter the main point of reference/contact person that the VBA should communicate with regarding membership.

Select Membership Level
Government/Country Membership $25,000
$5,000
$2,000
$2,000
$500
University/Academic Center $500
Health Insurance Agent $500
Terms & Conditions

By Clicking here I Agree to the Terms & Conditions applied for the Membership of the Voluntary Benefits Association (VBA).

Verify Security Code