Application Form
Funeral Consumers Assoc. (FCA) of Tampa Bay

Please print or type all information on the line above the information request.



Name:


Spouse:


Address:


City, State, Zip:


Phone Number:


If transferring, from what Association? (Please have the above listed Association send us a transfer letter stating you are a member in good standing.) The transfer donation is $10 per adult.



Membership donation enclosed: (There is a one-time life-time membership donation of $30 per individual or $50 per family: parents & children under 18.)


Please mail this form with your check (made out to the Association) to:
FCA of Tampa Bay, Inc.
M. Sandra Elmore, Membership/Treasurer
18902 Arbor Drive
Lutz FL 33548-5051
Upon receipt of this application and your check, you will receive:
  1. A Membership Card.


  2. The Schedule of Fees.


  3. The associated Funeral Home's name, address and phone number.


  4. Final Arrangement/Vital Statistics Form - on which you can list your funeral wishes. This Form can be accessed here and completed by you and sent with your application or we can mail you a Form with the Membership card for you to complete and return.


  5. Cremation Authorization Form - If you select cremation, it is necessary for your spouse (if still alive) or all of the children to each sign a Cremation Authorization Form. A form will be supplied by the Funeral Home at the member's Death.

If you have any questions, please contact Sandra Elmore by U.S. Mail, Phone or E-mail.


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