(Send to mailing address shown at bottom of form)

I               Last Name ______________            Father ______________   Mother ______________

                Address  _______________________________________________________________

                                   ______________________________________________________________                               

                Phone     _________________________________________________________

                I would like my phone number included in the website member directory [ ] Yes  [ ] No

                E-Mail    _________________________________________________________

                I would like my E-mail address  included in the website member directory [ ] Yes  [ ] No

                Children’s Names and Birth Dates:

                ______________________             _____________________                               _____________________

                _____________________                               _____________________                               _____________________

II             Where would you like to serve VHE                                                  

during the 2004-2005 school year?                                   

                [ ] Home School Band         [ ] Geography Bee                [ ] Monthly support group child care

                [ ] Chess Club                       [ ] Science Fair                                      [ ] infants               [ ] toddlers            

                [ ] Service Outreach             [ ] Spelling Bee                                     [ ] elementary        [ ] teens 

                [ ] Skating                              [ ] Talent Show                     [ ] Monthly support group set-up, clean up   

                [ ] Book-it                              [ ] Testing                              [ ] Monthly support group msc.       

                [ ] Field Trips                        [ ] Baseball                            [ ] Other ____________________________

                [ ] Art Fair                             

                What other homeschooling Co-ops or support groups do you belong to? _____________________

                What curriculum/methods do you use? _______________________________________________

                How long have you been homeschooling? _____________________________________________

What do you see as your most pressing needs as a home schooling parent? _______________________________________________________________________________

Do you belong to Home Educators Association of Virginia (HEAV)?   [ ]yes [ ]no

                Do you belong to Home School Legal Defense Association (HSLDA)?[ ]yes [ ]no

                (Please note that $15 discount to HSLDA is available to VHE members.)             

III            Membership Fee

This VHE membership covers the 2004-2005 school year and expires

August 31^st, 2005 regardless of the date payment was received.

[ ] $15  Annual Membership (before September 20^th, 2004)

[ ] $15  First time membership (joining anytime during the 2004-05 school year)

[ ] $20  Annual Membership Renewal (after September 20^th, 2004)

[ ] For an additional $3.70/year to cover postage, please print the monthly newsletters and send them to me by regular mail.

[ ] I am including a free will offering of ________________ (for the general fund)

[ ] I would like to talk to someone about a membership scholarship.

Amount enclosed _______________________________________

Return this Form to: Miriam Clark, treasurer, 4829 Shen Lake Drive, Harrisonburg, VA 22801