2016 FCC St. Louis Membership Registration
Please complete the form below to join the Families With Children From China - St. Louis chapter. Memberships runs from October 1, 2016 through September 30, 2017. If you have any questions about our activities, please visit www.fccstl.org or contact Ame Krippner, Membership Coordinator at Ame.Krippner@fccstl.org.
Thank you!

**If you are a renewing member, only complete the fields if you have had a change in the past year. Only items with a '*' are required fields for purposes of identification.

We are always taking volunteers, so please mark those with your choices!

Membership Status:
Parent(s) Name:
Your answer
Street Address:
Your answer
City, State, Zip:
Your answer
Home Phone:
Your answer
Cell Phone:
Your answer
Email Address / Electronic Communication:
Emails 1, 2, & 3 (if all used) will receive e-mail updates from our notification e-mail account, stlouisfcc@gmail.com. This is our PRIMARY notification method for all event registrations, newsletters, etc. If you do not wish to receive these updates, please send e-mail to stlouisfcc@gmail.com and let us know how you wish to be contacted.

NOTE: If you should change work e-mails during the membership, please let us know at stlouisfcc@gmail.com. The method with which we are sharing this Google Doc will not require you to have a gmail account or e-mail address.

E-mail 1:
Your answer
E-mail 2:
Your answer
E-mail 3:
Your answer
Adopted & Bio Children's Information
If current member, indicate additions ONLY. If you have more than 3 children, please email stlouisfcc@gmail.com with the rest!

Note: If your child will be graduating from high school this spring, please put their name and birth date information under Child #1 (even if you are a renewing member). STL FCC is now recognizing each graduate in May and this will ensure that we have your child on our contact list.

Child 1's Name:
Your answer
Child 1's Date of Birth
MM
/
DD
/
YYYY
Child 1's Adoption Date
(Just put a '1' in the Day field)
MM
/
DD
/
YYYY
Child 1's City, Province, & Country
Your answer
Child 1's Adoption Agency:
Your answer
Child 2's Name:
Your answer
Child 2's Date of Birth
MM
/
DD
/
YYYY
Child 2's Adoption Date
(Just put a '1' in the Day field)
MM
/
DD
/
YYYY
Child 2's City, Province, & Country
Your answer
Child 2's Adoption Agency
Your answer
Child 3's Name:
Your answer
Child 3's Date of Birth
MM
/
DD
/
YYYY
Child 3's Adoption Date:
(Just put a '1' in the Day field)
MM
/
DD
/
YYYY
Child 3's City, Province, & Country
Your answer
Child 3's Adoption Agency
Your answer
Volunteer To Help Our Chapter
Please select any boxes that apply. None of the volunteer opportunities listed below require you to be on the board.
Help at a specific event :
Write an article for the newsletter
Other ways I'd like to help:
Your answer
Talents I'd like to share:
Your answer
Other interests?
Right to Privacy:
Membership Fees
Registration Year October 2016 - September 2017:

Membership Dues:
$20 - Early Bird Family Membership (before November 1st)
$30 - Family Membership (after October 31st)
FREE - Waiting Families

Follow the link on the confirmation page to the payment instructions on our FCC page. **Please consider using PayPal as it makes our payment process much faster!**

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