Fagowee Membership Form

Directions:  Please print this form, circle the appropriate choice of membership, and mail with check to:
  Fagowees International
Washington Branch
P.O. Box 470
Temple Hills, MD 20757

Name: ________________________________________________
Nickname: ________________________________________________
Address: ________________________________________________
City: ________________________________________________
State: ________________________________________________
Zip: ________________________________________________
Home Ph #: ________________________________________________
Work Ph #: ________________________________________________
Date of Birth: (month/day) ________________________________________________
Email: ________________________________________________
New Members:

 How do you want your name to appear on your pin?
________________________________________________

New Members *
Individual

$25
Family

$30
Lifetime *
Individual

$200
Family

$300
Renewal *
Individual $20
Family $25

(*Includes membership pin)