FSCM Membership Application
Please complete application. Once completed, you will receive a confirmation email that will include payment instructions.
1. Name of Company *
Your answer
2. Is this a renewal or new application? *
3. Main Contact Name (This person will receive all notices and will represent the company at all meetings, etc. *
Your answer
4. Has your contact information changed in the last year? If you answer no, you may skip to question #10. If yes, please proceed. *
5. Main Contact Email
Your answer
6. Main Contact Address
Your answer
7. Main Contact Preferred Phone number
Your answer
8. What type of phone number is this?
9. Please list below any additional employees you wish to receive information, along with their contact information.
Your answer
Membership Fees - $500 for the first storefront, $150 for each additional storefront, with a maximum of $2500.
10. How many storefronts do you have? *
Your answer
11. Calculate your payment for Membership and enter total amount below. 1st store @ $500 + ____ stores at $150 each, or enter $2500 if applicable. *
Your answer
Political Action Committee (PAC) Contributions - Suggested contribution is $100 per storefront but any amount is helpful and accepted.
Payment must be either a separate check or a separate credit card payment.
12. Will you be contributing to the FSCM PAC? (Suggested contribution is $100 per store) Payment must be either a separate check or a separate credit card payment.
13. Calculate your payment for PAC Contribution and enter total amount below (if applicable). ____ stores @ $100 each
Your answer
14. How do you plan to submit payment? You will receive instructions in the confirmation email after submitting this form. *
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