Online Membership form

Membership Form

Please fill out this form in its entirety.

*Required fields are compulsory.

First Name

Last Name

Birthday

Month

Day

Year

Cell Phone

Spouse First Name

In the absence of spouse, please enter N/A

Spouse Last Name

In the absence of spouse, please enter N/A

Spouse's Email

Spouse's Cell Phone

Spouse Date of Birth

Month

Day

Year

Full address

Country/Region

Address

City

Zip / Postal code

Home Phone

Spoken Languages

Health Conditions (Any Special Needs)

Hobby/Interests

Emergency Contact 1

Cell Phone

Relationship to applicant

Emergency Contact 2

Relationship to applicant

Cell Phone

How will you pay your membership fee?

Online (Zelle)

Check

Cash

Date of signing up

Disclaimer: Participation in FISCO activities is voluntary and based on each member’s health condition and physical ability. By participating, members acknowledge and accept responsibility for any risks, injuries, or incidents that may arise during or as a result of participation.

Signature

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Membership is valid for life. The $200 fee is a one-time, non-refundable payment.