AZ FCCLA Logo

ONLINE AFFILIATION FORM
(FIELDS MARKED * ARE REQUIRED)
Existing Chapter

* Chapter ID

 
* Affiliation Type
New Chapter
Chapter ID Number * (Required for Existing Chapter, if you do not know yours, please call the State Office at 602-542-3040)
Have you changed your address since your last affiliation?
No
Yes
 
* Name of Chapter
 
* Name of School
 
* Address

* City

State

* Zip Code
 
* Telephone # (Include Area Code)
 
Ext.
 
* Fax # (Include Area Code)
 
* School Email Address

PRIMARY ADVISOR CONTACT INFORMATION:

 
 
* Advisor First Name

M.I.
 
* Advisor Last Name
 
* Home Address
 
* City

State
 
* Zip Code
 
* Telephone # (Include Area Code) 
 
* Best time to contact

 
* Years as advisor
 
* Home Email Address
Number of Additional advisors for this Chapter
If you are the only advisor put "0" for additional
Intra-curricular Chapter?
Yes
No
School Location
School Type
ENTER OF NUMBER OF MEMBERS FOR THIS PAYMENT BELLOW:
# of Males # of Females # of Comprehensive # of Occupational
* Total # Members for This Payment   * Total # Members YTD      
DEMOGRAPHIC COMPOSITION OF NEW MEMBERSHIP: (OPTIONAL)
# Caucasian
# African-American
# Asian
# Hispanic
# Native-American
#Other

 

* REQUIRED
This is our
First
Second
Third or More
Affiliation for the
2008-2009 School Year

2008 ARIZONA FCCLA
1535 W Jefferson Street Bin # 42
Phoenix, AZ 85007
www.azfccla.org
Phone: 602-542-3040
Fax: 602-542-1849