FMCA Auxiliary

Auxiliary Membership

The United States Association of Former Members of Congress Auxiliary Membership Form Name:________________________________________________ Mailing Address:__________________________________ City:________________________State:_________ Zip:_________ E-mail Address:__________________________________________ Telephone: Home_______________________________________ Cell________________________________________ Work_________________________________________ Place of Employment:______________________________________ Spouse (or former spouse):___________________________________ Please check if Former Member is deceased:_____ State represented in Congress:_______Dates of Service:______________ Annual membership dues are $40.00. Checks should be made payable to FMCA. Please mail this form with dues by December 31st to: Lea Ann Edwards 627 Potomac River Road McLean, VA 22102