Fiddletown Community Center
Membership Form

Membership is open to anyone having an interest in the Fiddletown Community Center. Membership is from January 1st through December 31st of each year. Membership dues are $10.00 per person (18 years or older).

Date ____________________

Name _______________________________________

Additional Names (family members, etc.):

____________________________________________

____________________________________________

____________________________________________

Address _____________________________________

City ___________________ State_________________

ZIP Code _________________________

Telephone_________________________

Email Address ________________________________

Please mail completed form along with dues (checks may be made payable to Fiddletown Community Center):

FCC
PO Box 236
Fiddletown, CA 95629