Membership Application

Membership Application Form

Membership dues are $80 per year. Please fill out the application form below and include your credit card information (Mastercard and Visa Accepted). Mission Statement: The Coalition Of Visionary Resources(COVR) is a non-profit trade organization dedicated to supporting independent retailers, manufacturers, distributors, wholesalers and publishers of visionary books, music, and merchandise. This is accomplished by focused servicing on a business-to-business basis, the retailer and wholesaler community in the visionary, New Age, metaphysical, alternative healing and spiritual industries. COVR also welcomes conscious based individuals or companies who demonstrate an active interest in seeing our market grow, succeed , and expand.

Company Name
First Name*
Name of Customer
Last Name*
Customer's last name
Email Address*
Customer's email
Website
Phone Number*
Customer's phone number
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Membership Category*
Face Book
LinkedIn
My Space
Twitter
Business Name & Description
Credit Card Type*
Credit Card Number*
Expiration Date *
CCV Number*
Membership/Yearly Fee*
- $80
Name As It Appears On Credit Card*
Billing Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Captcha

Membership Application

Membership Application Form

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