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Membership Application
The Fed membership fiscal year is January - December
Membership benefits include voting rights, submission of agenda items and application for Federation neighborhood grants.
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Please check appropriate box for dues
*
$15 Annual dues for individual members
$25 Annual dues for households
$75 Annual dues for neighborhood organizations or civic groups
Student (18 Years or less) $0
IF PAYING BY CHECK, MAKE CHECK PAYABLE TO FSRN • SEND CHECK TO: FSRN, PO BOX 151485, SAN RAFAEL, CA 94915-1485
Name(s)
Your answer
Address
Your answer
Telephone(s)
Your answer
Email(s)
*
Your answer
Neighborhood
*
Your answer
Neighborhood Association Name
Your answer
Neighborhood Interests
Start an neighborhood association
Emergency preparedness
Events
City Planning
City/Neighborhoods meetings
Traffic/streets
Safety/Police/Fire
Natural amenities (creeks, paths, open spaces)
Attend Steering Committee meetings
Other:
THANK YOU!
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