Type of Membership: Personal___ Church___ New___ Renewal___

Preferred mailing address: Residence___ Church___

Name:___________________________________________________________

Home Address:___________________________________________________

City:________________________ State_________ Zip Code______+____

Phone ______________________ E-mail __________________

Church Name :____________________________________________________

Church Address:___________________________________________________

City:________________________State_________Zip Code____________+________

Phone______________________ E-mail____________________________________


I would like to become a member or renew my current membership.  Choose your level of support.
Regular ($50)___ Sustaining ($100)___ Patron ($150)___ Life Membership ($600)___

Enclosed is my check in the amount of $__________ Date___________ ck#______

Please mail this form and your check payable to FABM to:
FABM Executive Secretary
3300 Fairlawn Dr
Columbus, IN 47203

Refund Policy: Membership Fees are non-refundable. 

For Office Use-Paid_______Received_______Deposited_______Computer_______Library_______Acknowledged______