Fairfax Federation Membership Application/Renewal

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Federation Membership Application/Renewal for Fiscal Year
(Please complete this form online, print out copy for your records (landscape mode) and then submit by
clicking submit button below. Please mail check with copy of printed form to address below)

Association Name: and address:				Date:
Position	Name	Address	Phone/FAX (xxx.xxx.xxxx)	E-mail
President
Treasurer
1st Delegate
2nd Delegate
3rd Delegate

Please indicate person and address above to send future membership renewals: District? Association Type?

Number of Residences in Association: Federation Dues: Organization's web site: Month new officers installed:

1. Number of votes and dues are based on association size.

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 treasurer @ fairfaxfederation.org.

3. Mail application form and check to:

THE FEDERATION
Attention: Membership
P.O. Box 3913
Merrifield, VA 22116-3913

4. Dues & Delegates

# of Residences	Dues	Voting Delegates
Under 100	$20	1
100-1000	$40	2
Over 1000	$60	3

Click here to pay by

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