Please fill out this form, print it, and send to:

Funeral Consumers Alliance of Northern California
P.O. BOX 161688
Sacramento, CA 95816

Yes, I (we) want to support FCA/Sacramento-NorthernCalifornia and receive information and planning forms. Please send to:

Name(s):____________________________________ Date: _________

Address

Street #:__________________________________________ Apt. #:________

City:__________________________________ State:____________________ Zip:________________

Phone: (          )_______ - _____________

E-Mail: ____________________________________

Enclosed is a voluntary contribution of $ ________($30 per person suggested).
I/We wish to transfer from ______________________________society @ $15/person.

Call me about sending a speaker to my group: Yes ______ No _____