Member Information Form

This Member Information Form is for new and renewing members. New members, please fill out all fields to the best of your ability. Renewing members, use this form, when necessary, to update your information. Note that a number of fields are required for proper matching to existing accounts.

Note: If you are a renewing member with no information to update, you are done with the renewal process! Don't feel compelled to submit this form.

You may access a PDF version this form to print and mail by conventional means if you so choose. Click here to access the PDF version.

PAGE ONE - BASIC INFORMATION

Please start by indicating the reason you are using this form today.

I am using this form to... *

Household Information

Household Name *

This is your last name. If your household has two last names, include both names and separate them with a slash.

Primary Email *

A reliable email address to use for important FCC-SoCal communications. If desired, this email can also be associated with an individual family member below.

Home Phone *

Street Address

City

State/Province

Zip Code

Zip Code Suffix

+4 digits (optional)

Region

Select a region that best indicates where you live.

Adoption Agency and/or Facilitator

Enter the name(s) of the adoption agency and/or facilitator you used for your adoption(s).

Are you a waiting family or prospective parent?

Waiting Family

Prospective Parent(s)

Directory Opt-Out

Check here if you DO NOT want your family included in a member-only FCC-SoCal directory.

First Parent

First Name

Middle Name

Last Name

Nick Name

Cell Phone

Work Phone

Willing to Volunteer

Yes

Volunteering Skills/Interests

Indicate any special skills or interests that will allow us to better match you to volunteer opportunities. Examples - writing, accounting, legal, web posting, design, etc.

Second Parent (if applicable)