Membership

Membership Form

Violent crime affects victims, their families, and loved ones physically, financially, and emotionally.

Membership enables one to join with others to assist victims of violent crime.

"*" indicates required fields

Student Volunteer

Service Professional

Agency/Bus. (up to 3)

Name *

Agency-Organization *

Address

Address Line 2

City

State

ZIP / Postal Code

Phone *

Fax

Email *

P.O. BOX 421 FORT LAUDERDALE FLORIDA 33302
Telephone: 954.357.5775 Ext. 5761