APPLICATION FOR MEMBERSHIP

Families with Children from China/New England

FCC/New England dues are $29 and provide membership for a calendar year, renewable in January. Members receive a subscription to "The China Connection" (including back issues for the current year), a copy of the FCC/New England Directory, and notices of calendar events throughout the year. 

PARENT NAME(S): ________________________________________________________

ADDRESS:________________________________________________________________

CITY/STATE/ZIP__________________________________________________________

HOME PHONE:____________________WORK PHONE(S):___________________________

FAX PHONE:_____________________E-MAIL ADDRESS:__________________________

Information on each of your children (please include ALL of your children for our directory!):

Name
Date of
Birth
Date of
Joining
Family
Facilitating Agency
Orphanage

Do you wish to be included in the FCC/New England Directory? [ ] yes [ ] no
(The Directory includes both adoptive and waiting families, and is distributed to individual members for personal use only. Some waiting families prefer to wait until after their adoption to be listed.)
Do you want to be on our e-mail list? ___Yes ___No
Are you willing to receive notice of events, etc., via e-mail instead of USPS mail? [ ] yes [ ] no
Please check if you are interested in the following sub-groups: [ ] Single Parents [ ] Waiting Families
Please check if you would like us to withhold your name if we share our mailing list ____
(The FCC board may occaisionally share its mailing list with organizations which might be of interest to its members.)
Make checks payable to FCC and send this to:
FCC/New England
Susan Avery, Membership
31 Central Street
Acton, MA 01720
978-635-1982
susan.avery@verizon.net
 Ideas for newsletter/areas of interest (and any other comments!):