Membership Application

Why become a COVA member?

·  Show support for COVA and demonstrate of your commitment to crime victims’ needs and the crime victims’ services field in Colorado.

·  Build strong associations and network within Colorado’s crime victims’ services field.

·  Get access to discounted registration rates to the COVA Conference as well as discounted rates on special COVA trainings throughout the year.

Join today or renew your membership by filling out the form below.

If you have already renewed please disregard.

New
Renewal

This membership is: Today’s date: ______

Select Type of Membership:

Individual – $50.00

·  Includes one discounted registration to the COVA Conference & discounted rates to special COVA trainings during the year.

Student / Senior (55+) / Volunteer – $25.00

·  Includes one discounted registration to the COVA Conference & discounted rates to special COVA trainings during the year.

Agency/Organization – See chart below

·  Includes unlimited discounted registrations to the Annual COVA Conference & discounted rates to special COVA trainings during the year.

Agency/Organization dues are based on an organization’s operating budget. If you are a government agency, please use the budget of your individual department. Check the box next to the budget that fits your agency:

Operating Budget / Membership Dues
Less than $250,000 / $150
$251,000 - $750,000 / $225
$751,000 and Higher / $300

Please complete the next page

Primary Contact (Please list the Primary Contact for this membership):

Name: ______

Organization: ______

Agency/Org. this membership is for (if different from above): ______

Address: ______

Phone: ______Fax: ______

Email: ______Website: ______

Check here if you do not wish to receive COVA emails.

Victims’ Services Online Directory:

For Agency/Organization Members Only. If you would like your agency or organization to be included in the victims’ services online directory, located on COVA’s website, please provide the following information:

Agency/Organization Name: ______

Address: ______

Business Phone: ______Crisis Line: ______

Email: ______Website: ______

Check here if your agency has multiple locations. We will follow up with you on how best to display this information in our directory.

In order to process your membership, you MUST:

1) Send this completed form to COVA via:

·  Email – ;

·  Fax – (303) 861-1265; OR

·  Mail – COVA, 1325 S Colorado Blvd, Suite 508 B, Denver CO, 80222

2) Submit payment to COVA:

·  To pay by check – Mail it to COVA, 1325 S Colorado Blvd, Ste 508 B, Denver CO, 80222

·  To pay by credit card – You can either pay online at www.coloradocrimevictims.org/pay-your-membership-online OR call COVA (303) 861-1160 and we will process payment over the phone.

Please contact us if you have any questions!

Colorado Organization for Victim Assistance

1325 S. Colorado Blvd., 508-B Denver, CO 80222

303-861-1160 or 1-800-261-2682 Fax 303-861-1265 Email: