FCC East Tennessee
Membership Form
(Use for New or Renewal Membership, Information Update and Volunteering)
Membership in FCC East Tennessee is on a calendar year basis and expires each year on December 31. Membership dues for calendar your 2008 are $20 per family.
Fill out this application and mail to: FCC-ET, P. O. Box 27860, Knoxville, TN 37927
APPLICATION TYPE (required)
_____New Member _____Renewal _____Updating Family Info _____Volunteering
CONTACT INFORMATION (required)
Print Name(s) __________________________________________
Address ______________________________________________
City_______________________ State________ Zip____________
Phone_____________________ E-mail ______________________
Are you a waiting family? ____ Yes ____ No
Please list your children by adoption or birth (Waiting Families, please send info when available):
First Child’s Name _____________________________________
Gender ___________
Birthdate _________________ Adoption Date _________________
State/Province of Birth ___________________________________
Social/Children's Welfare Institution _________________________
Adoption Agency________________________________________
Second Child’s Name ___________________________________
Gender ___________
Birthdate _________________ Adoption Date _________________
State/Province of Birth ___________________________________
Social/Children's Welfare Institution _________________________
Adoption Agency________________________________________
Third Child’s Name ____________________________________
Gender ___________
Birthdate _________________ Adoption Date _________________
State/Province of Birth ___________________________________
Social/Children's Welfare Institution _________________________
Adoption Agency________________________________________
Fourth Child’s Name ____________________________________
Gender ___________
Birthdate _________________ Adoption Date _________________
State/Province of Birth ___________________________________
Social/Children's Welfare Institution _________________________
Adoption Agency________________________________________
Fifth Child’s Name ____________________________________
Gender ___________
Birthdate _________________ Adoption Date _________________
State/Province of Birth ___________________________________
Social/Children's Welfare Institution _________________________
Adoption Agency________________________________________
Membership Directory
Do you wish to be included in the Directory? _____Yes _____No
Note: For entries with multiple Last/Family names, the complete listing will be by the alphabetically first of the names. A reference (i.e. Jane Smith-See John Doe) will be included for the rest of the names.
The Membership Directory is solely for the use of Members. No commercial use is authorized. No dissemination of the information in the Directory is allowed, unless expressly authorized in writing by the Board of Directors or unless required by law. By accepting the Directory, each Member of FCC-ET agrees that the member will not make commercial use of the Directory or allow any other person to do so. Additionally, except as required by law, each Member agrees that the Member will not disclose or allow others to disclose the information set forth in the Directory to any non-Member.
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Because FCC-ET is a fully volunteer organization, we need your help. Please choose one or more of the following (specify first choice, second choice and third choice):
_____ Board Membership - (need for 2008)
_____ Newsletter
_____ Cultural Events (Chinese New Year, etc)
_____ Culture Camp Volunteer
_____ Database Coordinator
_____ Playgroup Coordination
_____ Older Children’s (age 6 & up) Social Group Coordinator
_____ Volunteer Coordinator - (need for 2008)
_____ New Member Coordinator
_____ Membership
_____ Internet-Website
_____ Education (Language, Dance, etc)
_____ Business/Community Contact
_____ Public Relations
_____Waiting Families Support - (need for 2008)
I do not want to be on a committee but you can contact me for possible:
_____ Help with FCC event _____ Newsletter article
_____ Host an FCC committee meeting _____ Other
I may be able to provide my special skills or connections (please specify such things as special computer skills, copying services, etc.):
________________________________________________________________________________________
I have some good ideas or connections for spaces to use for future events/meetings:
________________________________________________________________________________________
Here are my ideas for programs for future events:
________________________________________________________________________
Other things I would like to see our organization do and become are:
_________________________________________________________________________
How did you hear about FCC East Tennessee?
__________________________________________________________________________
Questions? Please contact our member contact person, Joy Powers. E-mail her at FCCEastTN@yahoo.com or call 865-281-7591.
Please be advised that FCC East Tennessee holds the right to publish, in our newsletter and/or on our website, any photographs taken at FCC-ET sponsored events. Individuals appearing in the photographs will not be identified by name without prior authorization from the individual(s).