FICRA Building Trust Membership Registration/Renewal FICRA Building Trust Membership Registration/Renewal To renew your membership or to become a new member, please complete the FICRA Membership Form. You may fill out the form and pay online via PayPal, or you may download, complete and mail the form to FICRA at PO Box 25, Fox Island, WA 98333. Thank you for your support! Instructions for using this Form This online form may ONLY be used if you are able to pay online via PayPal. You do not need to have a PayPal Account to use their payment service. When you click the button at the bottom to submit this form, you will be directed to a PayPal payment screen. If you click the Pay with Debit or Credit Card link at the bottom of the PayPal screen, you can pay without signing up for an account. DO NOT USE THIS ONLINE FORM if you are unable to pay online via PayPal. If you can not pay online, you should download and print out our form, complete it and mail it with your payment to FICRA Building Trust at PO Box 25, Fox Island, WA 98333. If you see a red asterisk (*) next to a field name, you must fill out that field with the correct information or you will be unable to submit the form. If the form is rejected because the required information was not included, you may have to fill out some of the fields all over again. Please note that this online form is difficult to fill out on a phone screen, since the layout may change. We strongly recommend you use a desktop system or large tablet. (Hint – when filling out this form, you can use the tab key on your keyboard to move to the next field.) PRIMARY MEMBER First Name & MI * Last Name * Primary Phone Nbr * Addl Phone Nbr EMail Address * Please check all applicable boxes: I Live on Fox Island I Do Not Live on Fox Island I Own Property on Fox Island Residence Address * Please do not enter a PO Box in this field. This field is used to determine if you reside on Fox Island or somewhere else. City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Do you have a separate mailing address? * Yes No Provide a mailing address that you would prefer we use instead of (or in addition to) your residence address. Mailing Address PO Box or Nbr/Street Mailing City City Mailing State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Mailing Zip Code Zip Code Is there another person in your household? * Yes No ADDITIONAL HOUSEHOLD MEMBER Please complete this section if there is an additional person in your household that shares your membership. Addl First Name & MI Addl Last Name Addl Phone Nbr Addl EMail Address VOLUNTEERING Are you interested in doing more to help out your community? I am interested in: Organizing activities/events Helping out at activities/events Helping with the newsletter and other communications Joining Neighborhood Watch OtherOther ADDITIONAL INFORMATION (Optional) Additional Information Enter any additional information you would like to provide with your Membership Application/Renewal. ANNUAL DUES Fee 1 Title Annual Dues * FICRA BUILDING TRUST DONATIONS Fee 2 Title Trust Donation Fee 3 Title Neighborhood Watch Donation Fee 4 Title Emergency Planning Donation TOTAL DUES/DONATIONS We use PayPal to process payments, but you do not need to have a PayPal Account to make a payment. Just click the “Pay with Debit or Credit Card” link when you see their screen to enter your information without signing up for an account. Dues Subtotal Donations Subtotal Total Due Submit Registration/Renewal and Pay Via PayPal Clear and Reload Form Captcha If you are human, leave this field blank. Δ
