Volunteer Fairfax Membership Information Form
RequiredRequired Question(s)
Required 1.

Agency Name:
 

50 characters left.
2.

Agency Address (please include city, state and zip):
 

350 characters left.
3.

Agency Website:
 

50 characters left.
Required 4.

Name of Main Contact:
 

50 characters left.
Required 5.

Main Contact Email Address:
 

50 characters left.
6.

Main Contact Phone Number:
 

50 characters left.
Required 7.

Please select which of the below options best describes your organization:
501(c)3 - Nonprofit
Fairfax County Government Agency
Government Agency (Non-Fairfax County)
Corporation (Non-501(c)3)
Other  
Required 8.

Which membership level are you interested in receiving?
Registered (Free)
Associate ($50/year)
Partner ($100/year)
Please send me more information about the different membership levels.
9.

What service are you most interested in receiving through Volunteer Fairfax programs?
 

350 characters left.