Print out this form from your browser and send it with your check

NOTE: No information sent to FCTA will be disclosed by FCTA to any other
      organization or non-FCTA individual except at your request

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I wish to make a gift of Membership in the FCTA to:

_____________________________________________________________________
(Recipient's Name)

_____________________________________________________________________
(Recipient's Mailing address)

______________________________________________ _ _ _ - _ _ _ - _ _ _ _
(City/State/Zip)                                     Telephone No. 

E-mail address:___________________________ @ _________________________

[  ]  Please send gift notice to recipient in my name.
   *     *     *     *     *       *     *     *     *     *     *

______________________________________________________________________
Donor's name

______________________________________________________________________
Donor's Mailing address

______________________________________________ _ _ _ - _ _ _ - _ _ _ _
City/State/Zip                                      Telephone No.

Donor's E-mail address:____________________ @ _______________________

[  ] Payment for gift membership @ $15/yr            $________ . ___  

[  ] Extend my membership for ___ year(s) $15/yr    $________ . ___

[  ] Please accept my gift of ______ to help help FCTA
      fight for lower taxes in the County            $________ . ___   

                 Total Amount Enclosed:              $________ . ___
 
Please mail to: Fairfax County Taxpayers Alliance, Inc.
                P.O. Box 356
                Fairfax, VA  22030

GIFTS ARE NOT TAX DEDUCTIBLE 
because the FCTA tries to influence Tax legislation.

webRev: June 19, 2001