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Federation Membership Application/Renewal for Fiscal Year
(Please complete this form on line, print out copy for your records (landscape mode) and submit by
clicking submit button below and then mailing check with copy of printed form to address below)
  Association Name and address   Date:
Position Name Address Phone/FAX ( E-mail see note #2
 1st Delegate
 2nd Delegate
 3rd Delegate
 4th Delegate
 Please indicate person and address above to send future membership renewals:  District?   Association Type?
 Association Size/Federation Dues  Organization's web site  Month new officers installed:
 1. Number of votes are based on association size. Dues are based on association size and number of mailed bulletins (see chart below):
 2. Membership dues are from July 1 to June 30 of the following year. Separate invoices may not be mailed. To determine whether your association's membership is current check with the Federation Treasurer at fedtreas2019 @
 3. Mail application form and check to:
Attention: Membership
P.O. Box 3913
Merrifield, VA 22116-3913
 4. Dues, Delegates, & Bulletins
# of Residences Dues Voting Delegates Bulletins
Under 100 $20 1 + $10 per each mailed
100-1000  $40 2 + $10 per each mailed
Over 1000 $60 3 + $10 per each mailed
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Fairfax County Federation of Citizens Associations, P.O. Box 3913, Merrifield, VA 22116-3913,
2005 - FCFCA; FedWebmaster2019 @