Application 2026-2027

Application 2026-2027

P.O. Box 62191 Fort Myers, FL 33906 www.fmwcc.net
Title*
Name*

First NameMiddle or Maiden NameLast Name
Occupation (retired, student, etc.)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Second Phone Number if applicable (land line/out of area line)
Please enter a valid phone number.
Email*
example@example.com
Type of Membership*
Spouse occupation
Spouse name

First NameLast Name
Children under age 25 residing in Lee County. NAME, M/F, Birthdate & Grade in school. (Please list each child on a separate line.)
Grandchildren under age 25 residing in Lee County. NAME, M/F, Birthdate & Grade in school. (Please list each child on a separate line.)
check here
check here
check here
check here
check here
check here
Other (you can write in a special skill)
Choose 1: Membership is May1, 2026-April 30, 2027. You must be paid by midnight on September 10, 2026 in order to vote for the 2027 King and Queen of Edisonia.*
prevnext( X )
Membership
includes credit card processing fee

$62.68 Quantity

Membership writing check for $60 and mailing to P.O.Box 62191 Fort Myers, FL 33906

$ Free Quantity

Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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