NATIONAL ASSOCIATION OF FARMER ELECTED COMMITTEES

Membership Application / Renewal Form

NAME:

ADDRESS:

CITY/STATE/ZIP:

PHONE NUMBER:

E-MAIL:

Would you prefer to have the newsletter send electronically to you?   Yes____  No­­­­____

Are you submitting an FSA-444 to your County FSA office for automatic dues withholding?     Yes*____  No____

If yes, please remember to send your personal information to NAFEC or have your FSA office do so.

____ Committee member…$35

____ FSA employer or Associate member…$20

____ $3.00 per meeting (444 dues withholding only)*

*Please check with your staff to set up your 444

If paying by check, please make payable to NAFEC

Please send membership information and/or questions and comments to:

Tom Ardoin, Secretary / Treasurer

NAFEC

P.O. Box 400

Pine Prairie, LA 70576

Phone / Fax: 337-599-2783

Mobile: 337-831-0671

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