Central Alabama FCC - Membership Enrollment Form

Please complete and print the following form and mail it with your annual dues of $20 to:
Families With Children From China,  P.O. Box 383174,  Birmingham, AL 35238
  Name E-mail Address
Parent 1:  
Parent 2:  
Mailing    
Address:  
Phone:  
 
Child's Name		  
Date of Birth		 Date of Adoption
(if applicable)

Your Current Adoption Status:
Paperchasing
Waiting for referral - Date dossier arrived in China (aka DTC):  
None of the above

Volunteer:
Would you like more information about leadership opportunities in our chapter?
Yes    No

Additional Comments: