Fathers Are Capable Too ( F.A.C.T.) - Full, Voting Membership Application

Name __________________________________________________________________________ Birthdate________/________/________

Address ________________________________________________________City _____________________________________________

Province/State _________________________Country ______________________________ Postal/Zip Code ________________________

Home Phone _________________________ Work Phone ___________________________ Fax Number __________________________

E-mail address ___________________________________________________________________________________________________

Occupation ______________________________________________________________________________________________________

Special Skills you are willing to share _________________________________________________________________________________

Children

Name: _________________________________________________________________ Sex M / F Birthday ________/________/________

Name: _________________________________________________________________ Sex M / F Birthday ________/________/________

Name: _________________________________________________________________ Sex M / F Birthday ________/________/________

Name: _________________________________________________________________ Sex M / F Birthday ________/________/________

Name: _________________________________________________________________ Sex M / F Birthday ________/________/________

Reasons for joining: _______________________________________________________________________________________________

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Your main concerns about your situation: ______________________________________________________________________________

________________________________________________________________________________________________________________

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Please enclose a non-refundable cheque/cash of $40.00 Canadian for a 1 year full voting membership in
Fathers Are Capable Too: Parenting Association.

Please send your application to:

Fathers Are Capable Too (F.A.C.T.)
3044 Bloor St. W., Suite 205
Toronto, Ontario, Canada M8X 1Y6

Signed _________________________________________________________________ this _______ day of _____________, __________