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FOCUS Women's Resource Center Membership Form
Your membership sustains empowerment programs and support services
for thousands of area women and their families.

Your membership is 100% tax deductible.
FOCUS Women’s Resource Center is a 501(c) (3) charitable organization.


PLEASE FILL OUT YOUR INFORMATION BELOW

YES! I want to become a member of the FOCUS Community
( ) $35 Basic  ....( ) $20 Senior/Student ....( ) $50 Supporter
( ) $100 Friend ....( ) $250 Sponsor  ....Other__________
( ) I am not interested in being a member, but I would like to support FOCUS $____________
( ) Enclosed is my check for $_____________
(We) prefer to pledge $________ (total amount)
Please remind me (us) on _________  or ( ) semi-annually    ( ) quarterly    ( ) monthly
I (We) wish to charge $_________ to VISA     MasterCard (please circle)
Card #__________-___________-_____________-___________ Expiration Date___________
 
Signature______________________________________________Verification # ___________
 
Name
Address
City
 State Zip
Home Phone
E-mail
I am interested in:
( ) Volunteer opportunities ( ) Upcoming events ( ) Making a gift of securities ( ) Bequest procedures


Please make your checks payable to:
FOCUS Women's Resource Center, 953 Second Street, SE, Charlottesville, VA 22902
For further information, call the Executive Director at 434-293-2222 or e-mail alugo@focuscville.org
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