FAIRFAX COUNTY TAXPAYERS ALLIANCE
MEMBERSHIP FORM

Fairfax County Taxpayers Alliance (FCTA) dues are $15 per family for 12 months.

To join the FCTA, just print this page (or copy and paste it to your word processor and print it) and mail it with your check to:

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

or join online
___ Please enroll me as a member of the FCTA. Enclosed are one year's membership dues of $15.

___ I am enclosing an extra contribution of $ ___________.

___ Please send me an FCTA "CUT TAXES" bumper sticker.


__________________________________________________________
Name

__________________________________________________________
Street/P.O. Box

__________________________________________________________
City/State/Zip

__________________________________________________________
E-mail address

__________________________________________________________
Telephone

___ 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.

November 11, 2006