How to Join FCCC

Please print this form and provide the information requested. Checks should be made payable to the Fairfield Community Coordinating Council and mailed with the completed form to: 

FCCC
P.O. Box 917
Winnsboro, South Carolina 29180

 

Membership Year: 
January 1, 20____ to December 31, 20____
 

Membership Category:

___Organization/Agency ($25 annual dues)

___Individual ($5 annual dues)
 

Current Membership Status:

___Continuing Member

___Former Member

___New Member
 

Name of Organization or Individual:

_______________________________________________________
 

If Organization, name of Main Contact Person:

_______________________________________________________
 

Mailing Address: ________________________________________

_______________________________________________________
 

Email Address: __________________________________________

Daytime Phone: ________________ Fax: _____________________