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*  The Florida Network of Catholic Home Educators    *
*              MEMBERSHIP APPLICATION                *
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*                                                    *
* Name ____________________________________________  *
*                                                    *
* Street __________________________________________  *
*                                                    *
* City,State,Zip __________________________________  * 
*                                                    *
* Phone Number   (__ __ __) __ __ __ - __ __ __ __   *
*                                                    *
* Fax Number     (__ __ __) __ __ __ - __ __ __ __   *
*                                                    *
* E-mail Address _________________________________   *
*                                                    *
* ___ Yes, I would like to become a member of the    *
*     Florida Network of Catholic Home Educators.    *
*                                                    *
* ___ I would be interested in getting a discount    *
*     on my Home School Legal Defense Association    *
*     membership fee.                                *
*                                                    *
* ___ You may give my name and phone number to       *
*     prospective home education families in my      *
*     area.                                          *
*                                                    *
* ___ Yes, I belong to a support group already:      *
*                                                    *
*     group name ________________________________    *
*                                                    *
*     group location ____________________________    *
*                                                    *
*     group contact person ______________________    *
*                                                    *
* ___ Yes, I am currently a support group leader     *
*     and would like information on leader meetings. *
*                                                    *
* ___ Yes, I am interested in serving on a committee *
*     for the Florida Network of Catholic Home       *
*     Educators.                                     *
*                                                    *
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*              Membership Fee    $15/year            *
*                                                    *
*     (includes quarterly newsletter, updates on     *
*   Catholic Homeschooling, and discount to FNCHE    *
*                Statewide Conference)               *
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*       Make checks payable to, and send to:         *
*                                                    *
*             Donna Selkey (Treasurer)               *
*                 35246 US 19N #306                  *
*              Palm Harbor, FL  34984                *
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