Membership Form

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Please list all family members that should be included on your family membership. Note: all additional family members are included in the price of your membership at no additional charge!

We recommend including any spouse/partner and children at your household. You may also choose to include additional caregivers such as grandparents, nannies, or au pairs, if you wish. Family members with an email address will be given a login to the system (recommended for spouses) and family members without an email will not be able to login (recommended for children).

Want to further support FAN through a donation towards our annual operating expenses? Add a donation of any kind if you wish, below.

Annual FAN Membership

I would like to automatically renew my membership

Secure Payment

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First Name *

Last Name *

Submit as a company

Company Name

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Phone 1

Gender

Race/Ethnicity

American Indian or Alaska Native

Asian

Black

Hispanic/Latino

Native Hawaiian or Other Pacific Islander

Two or more races

White

Prefer not to answer

Secure Payment

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What is your preferred communication method from FAN?

Facebook via the FAN Winchester Page

Facebook via the Private FAN Winchester Group

WeChat

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What cultural events are important to your family? Where can FAN increase programming?

Are you willing to help with programming for any special topics?

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Membership Agreement *

Yes

Please review the membership agreement at: www.fanwinchester.org/membership-agreement

Photo Waiver *

Yes

Please review the photo waiver at www.fanwinchester.org/photo-waiver

Secure Payment

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Include a family member on your account

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Choose Existing Contact(s)

Membership Level *

I would like to automatically renew my membership

Family Member Role

Please list whether the sub-member is a child or spouse of the primary member or is another type of caregiver.

First Name *

Last Name *

Leave blank if this is a child or you would not like this sub-member to receive email communications.

Gender

Birthday (or Due Date)

Add {{subMemberDisplayName}}

Secure Payment

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{{orderSummary.membershipsTotal==0?'Free':formatAmount(orderSummary.membershipsTotal)}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

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Discount Code

Code:

-{{formatAmount(orderSummary.codeDiscount)}}

Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}

Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

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Card

or enter your card details below

Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

Swipe

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Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip

Country

Amount:

{{formatAmount(totalAmount)}} USD

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Join the Family Action Network

Membership level allows for a maximum of {{term.subMemberAllowed}} submembers.

	Contact Name	Membership Level
	{{item.contactName}}	{{item.membershipLevel==null?'-':item.membershipLevel}} {{item.startDate}} - {{item.endDate}}
No contacts.