Membership Form

First and Last Name of Individual/Couple as Noted on License

If Couple, First and Last Name of Second Individual as Noted on License (put N/A if single membership)

Street Address

City

State

Zip Code

Phone

Resource Family Type(required)

Foster Relative Non-Relative Adoptive

Are you a newly licensed Resource Family with Alameda County? If yes, no dues are required.(required)

Yes No

Membership Type(required)

Licensed Couple: $60/year Licensed Single: $45/year Unlicensed Couple: $60/year Unlicensed Single: $45/year

Membership dues expire on December 31st. Indicate below how you would like your dues to be applied? Please select only ONE option.(required)

I am a first year member and not submitting payment this year Apply my payment to this year's membership OR Apply my payment to next year's membership

How would you like to receive the CA State Foster Parent Newsletter?(required)

Email Mail

If you are a returning member, what member benefits do you appreciate the most? What recommendations do you have for additional offerings or ways we can improve our services?

We are always looking for volunteers to support our activities and fresh faces on the Board. Please let us know which of the following opportunities interest you. Check all that apply:

If you chose Other, please explain below:

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