Membership Discount Request

indicates a required answer

Families Instructing Students at Home, Inc. (FISH) is a 501c3 nonprofit organization committed to supporting families in all circumstances. If you are experiencing financial hardship or have another reason for needing a discounted membership fee, please complete this confidential form.

1. *	Full Name

2. *	Email address

3. *	Phone Number

Standard membership fee is $95 per family.

4.	Amount you are are able to pay (optional).

5. *

Please briefly explain your reason for requesting a discuount:

Include any relevent information such as a jobloss, single income, medical expenses, or other personal reasons.

Optional support or skills exchange

6. *

Are there any services, skills or volunteer time you could offer in exchange for a partial discount?

Event help, photography, administrative support, etc. (type "no" if not)

Agreement

7. *

By submitted this form I agree that my information will be shared confidentially with FISH leadership in order to evaluate my request.

(1 required)

I agree

8. *	Digital Signature
	By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.