FAIRFAX COUNTY TAXPAYERS ALLIANCE
MEMBERSHIP FORM

Fairfax County Taxpayers Alliance (FCTA) dues are $25 per family for 12 months.
To join the FCTA, just print this page and mail it with your cash or check to:

Fairfax County Taxpayers Alliance
P.O. Box 356
Fairfax, VA 22038-0356

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    ____ Please enroll me as a member of the FCTA.
          Enclosed are one year's membership dues of $25 (cash or check).

    ____ I am enclosing an extra contribution of $________
 
    ____ Please send me an FCTA "CUT TAXES" bumper sticker.
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    Full Name: _____________________________________________________________

    Street:    _____________________________________________________________

    P.O. Box:  _____________________________________________________________
 
    City:      ________________________   State: ______   Zip: _____________
 
    E-mail address: _____________________________   Telephone: _____________
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    ____ I would like to volunteer.

    ____ Please contact me.

         I heard about the FCTA through the:

         ____ FCTA Bulletin    ____ Personal Contact    ____ FCTA website

         ____ Newspaper        ____ Other


THANK YOU FOR YOUR SUPPORT!
Dues and gifts are not tax deductible.