Please complete the Full Membership form below. This is a requirement for FCCMA membership.
Salary (Required for dues calculation):
ICMA Recognized Government?:
Do you have a college degree?
If yes, what degree?
Date of Graduation:
If yes, ICMA Membership Category:
Have you ever been convicted of a felony or misdemeanor?
If yes, please explain:
Have you ever been denied membership or had your membership revoked in ICMA or any other state association?
Where did you hear about FCCMA?
What are you looking for in the Association?
Experience in Government:
1. Name of Government:
Years Served (Dates):
2. Name of Government:
3. Name of Government:
4. Name of Government:
I, , chief administrative officer for the municipality or county of , hereby certify that the above-named individual is qualified for full membership status as outlined in the FCCMA Strategic Plan and Membership Directory.
Signature, Chief Administrative Officer
We may contact these persons to verify their endorsement of you.
By my signature below, I certify that the information supplied above is true to the best of my knowledge. I have read and agree to comply with the Code of Ethics of ICMA and FCCMA to the extent that they apply to private companies.