Join HEAV Now!
Membership Information
Membership Status
Please select...
Active
Inactive
Non-member
Blank
Lifetime
Are you an HEAV Member?
Yes
No
HEAV Membership Number
HEAV Membership Expiration Date
Previous HEAV Membership Level
Membership Level
Please select...
Freedom Friend - $45/year
Freedom Defender - $150/year
Freedom Superhero - $300/year
Lifetime - $1,500 One-Time
Membership Payment Options
Please select...
Pay In Full (one-time payment of $45)
Pay In Full Annually (recurring annual payments of $45)
Installments (3 monthly payments of $15 each)
Pay In Full (one-time payment of $150)
Pay In Full Annually (recurring annual payments of $150)
Installments (12 monthly payments of $12.50 each)
Pay In Full (one-time payment of $300)
Pay In Full Annually (recurring annual payments of $300)
Installments (12 monthly payments of $25 each)
Pay In Full (one-time payment of $1,500)
Installments (5 monthly payments of $300 each)
Number of Payments
Billing Frequency
Installments Agreement
Since you have chosen installment payments, you authorize HEAV to charge each payment to your credit or debit card and agree to maintain a valid credit or debit card that expires no earlier than your final payment.
Signature
Date
Annual Payment Agreement
Since you have chosen to renew your membership automatically every year, you authorize HEAV to charge your credit or debit card once every 12 months. You may cancel your automatic renewal at any time
by notifying HEAV
.
Signature
Date
Account Number
Household Details (used for mailings)
Prefix
First Name
Last Name
Suffix
Company Name (optional)
Billing Street
Billing City
Billing State/Province
Billing Zip/Postal Code
Household Phone
Email
Auto-renewal
Would you like to make a tax-deductible gift to HEAV?
Yes, I will support HEAV with a tax-deductible gift of:
$
Totals
Today's Membership Payment
$
Total Charges
$
Payment Method
Credit Card
I will mail or call office with payment
Credit Card Information
Card Number (Visa/MC Only)
MM
YY
Code
Credit Card Expiration Date and Code
HEAV does not accept American Express or Discover.
Authnet_Hidden_Fields
Submit Payment
Your payment will be processed when you click on
Submit
.
Thank you so much for your support! You will receive an email confirmation shortly. Please contact the office if you have any questions.
804-278-9200
reCAPTCHA helps prevent automated form spam.
The submit button will be disabled until you complete the CAPTCHA.
Contact Information