Fox Island Alliance

Join Us

Fox Island Alliance, Inc.
Membership Application

Name: _____________________________________

Street: _____________________________________

City, State, Zip: ______________________________

Day Phone: (______)___)_______________________

Night Phone: (______)_________________________

E-Mail: ____________________________________

Date: _____________________________________

:Please check one:

_____ Senior $5
_____ Student $5
_____ Individual $15
_____ Family $20
_____ Sustaining $30
_____ Patron $50

Contributions:
_____ Exhibit Fund $ _____
_____ Education Fund $ _____
_____ Scholarship Fund $ _____

Check below if this membership is a gift:

_____

This is a gift from:

(Print your name here) ___________________________________

_____ I’m interested in volunteering. Please contact me.

Mail to:

Ed Powers
FIA Membership
12206 Yoder Rd,
Roanoke, IN 46783

Make checks payable to: FIA, Inc.
We are a volunteer organization.
Membership dues or gifts are Tax Deductible 501C3