Fairfax Federation Membership Application/Renewal

Return to Membership Please tell us who is completing this form: and your email address:

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 (xxx.xxx.xxxx)	E-mail see note #2
President
Treasurer
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. Bulletin notices are distributed by e-mail at no cost. Mailed Bulletins are $10 per subscription. Unless otherwise noted, email addresses provided above will be added to the Federation's email list for distribution of Federation notices

3. 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 fedtreas2009 @ fairfaxfederation.org.

4. Mail application form and check to:

THE FEDERATION
Attention: Membership VicePresident
4022 Hummer Road
Annandale, VA 22003

5. 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

Please print this page landscape mode using the properties box