Fagowee Membership Form


Directions:  Information is for club use only and is not shared with others.
Please print this form, circle the appropriate choice of membership, and mail with check to:
 
Fagowees International
Washington Branch
P.O. Box 22516
Alexandria, VA 22304

 

Name: ________________________________________________
Nickname: ________________________________________________
Address: ________________________________________________
City: ________________________________________________
State: ________________________________________________
Zip: ________________________________________________
Country:  ________________________________________________
Phone #: ________________________________________________
Cell #: ________________________________________________
Birthday (mm/dd): ________________________________________________
Email: ________________________________________________
Newsletter Preference:  _____ Postal Delivery   ____ Electronic Delivery
   
Family Membership - Second Adult
Name: ________________________________________________
Nickname: ________________________________________________
Cell #: ________________________________________________
Birthday (mm/dd): ________________________________________________
Email: ________________________________________________

 

New Members 
Individual:   $30
Family:   $40
Lifetime 
Individual:  $400
Family:  $500
Renewal 
Individual:   $25
Family:   $35

(*Includes membership pin)