KAFCE
2021 Membership Form***Type or Print Clearly in ink******Do Not Abbreviate State Street Names, City, County, or State***Date______________ Current Member ID#______________________First Name________________________ M.I.______ Last Name ____________________________Mailing Address__________________________________________________________________City _____________________________State _____________Zip Code +4___________________Phone No. ________________________ Cell Phone No __________________________________E-mail _______________________________________ County of Residence _________________Club Name ___________________________________Club County ________________________Family Membership: (Please list) Spouse Name _______________________________________Dependent Child (ren) _______________________________________________DuesIndividualFamilySenior(80+ years)YouthUnder18Kansas InformationNational $30.00$40.00$26.50$5.00Area: NE NW SC SE SW(Circle One) State 10.00 20.00 10.000Birth Date (MM/DD/YYYY)Council/County/ParishDate joinedClubDate dropped /Date re-joinedContribution/Donation to KAFCE *Contribution/Donation to NAFCE*Contribution/Donation to ACWW*Total*Refer to the Dues and Contribution Report Form list of choices that you may choose to supportSign and send with total membership dues to Club Treasurer by _________________Member Signature__________________________________________________________Must be original signature, copies will not be acceptedPLEASE INDICATE: (Check all that Apply)____New Member (Never belonged to FCE before) ____Change of address, etc.____ Re-joined (Have not belonged for a time)____Club President - 2021____ Independent Member (Does not belong to a FCE Unit) ____County Council President - 2021Mission…To strengthen individuals, families, and communities through continuing education, developing leadership, and community action.(Revised August 01, 2020) ................
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