FAIRFAX COUNTY ALLIANCE FOR HUMAN SERVICES
2022-2023 MEMBERSHIP REGISTRATION
www.fairfaxalliance.org
DATE
NAME
MAILING ADDRESS
PHONE (day) (night)
Check one: [ ] Renewal New Member
Check one: [ ] I'm registering as an individual OR
[ ] I'm registering as an organization's representative ( ).
The organization I represent is: __________________________________________________________
Please check here if we may list your organization as an Alliance member in our printed materials.
I would like to get involved in the Alliance's work. Please call me.
Please consider a contribution to advance the Alliance's work!
Enclosed: $ 5.00 Alliance Dues
$ ________ Contribution
TOTAL: $ ________
Please mail this completed form along with cash or a check for your TOTAL payable to Fairfax County Alliance for Human Services (or FC Alliance for Human Services) to:
Fairfax County Alliance for Human Services
c/o Jemal Finney
1353 Monroe St. NW
Washington, DC 20010
DATE_____________________________________________________________
NAME____________________________________________________________
MAILING ADDRESS ________________________________________________
__________________________________________________________________
PHONE (day)___________________(night)___________________E-MAIL___________________
Check one: _______ Renewal _______ New Member
Check one: I'm registering as an individual ( ) OR
I'm registering as an organization's representative ( ).
The organization I represent is: __________________________________________________________
_____ Please check here if we may list your organization as an Alliance member in our printed materials.
_____ I would like to get involved in the Alliance's work. Please call me.
Please consider a contribution to advance the Alliance's work!
Enclosed: $ 5.00 Alliance Dues for 2020-2021
$ _____ Contribution
TOTAL: $ ________
This form, along with a check for your TOTAL payable to Fairfax County Alliance for Human Services (or FC Alliance for Human Services), should be mailed to:
Fairfax County Alliance for Human Services
c/o Jemal Finney
1353 Monroe St. NW
Washington, DC 20010