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's Information
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)