VEPGA Designated Contact Form

Designated Contact Form

Each member must designate one contact person to serve as the conduit for information between the association and the member. Most communications are by email, so it is important to provide an email address. Please designate a contact person and provide the following information:

Question Title

* 1. Organization

Question Title

* 2. Last Name of designated contact person

Question Title

* 3. First Name of designated contact person

Question Title

* 4. Contact Information

Address

City

State

ZIP

Email Address

Phone Number