Filipino-American Civic Employees of Seattle (Non-profit association)
P. O. Box 21831 Seattle, Washington 98111- 4337
www.facesseattle.org

Name: _________________________________________________________

Home Address: __________________________________________________

City, State, Zip: __________________________________________________

Home Phone: ____________________      Work Phone: _________________

Home E-mail address: ____________________________________________

Work E-mail address: _____________________________________________

Job Title: ______________________________________________________

Department: ___________________________________________________

Mail Stop: _____________________________________________________

Type of Membership:
r Regular (Dues: $12.00 per year)   r Honorary (No dues)   r Chapter (No dues)

Membership in Other Associations:

r  Bylaws Committee
r  Civic Committee
r  Dance Troupe
r  Education Committee
r  Employment Practices Committee
r  Finance/Ways & Means Committee
r  Fundraising Committee
r  Internal/External Relations
r  Internet Home Page
r  Leadership Institute
r  Member Database Maintenance
r  Membership Committee
r  Mentoring
r  Newsletter Committee
r  Nominations/Elections
r  Public Relations
r  Scholarship Committee
r  Social and Recreation Committee
r  Training Conference

(Please notify the FACES Secretary or your department’s FACES representative if you have a change of name, address, phone #, department, mail stop, etc. See reverse for Membership Information.)

Applicant’s
Signature: __________________________________   Date: _____________

For FACES Use Only

Date

Initials

Application Received

PD sent to Finance

Check sent to Treas.

Database Entry

Member Notified

FOR PAYROLL DEDUCTION

I hereby authorize the City of Seattle and the Officers of FACES to deduct Fifty Cents ($0.50) the first and second pay period of each month from my warrant to cover my yearly FACES membership. This deduction is to continue each year until revoked in writing.

Name: ________________________________  Signature: ___________________________

Employee Number:_______________________  Phone: _____________________________

Department: ____________________________________  Date: _______________________

Please mail your completed application form to:

FACES
P. O. Box 21831
Seattle, WA 98111-4337