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Membership Renewal
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Personal Information
* Login Name:
* Login Password:
* Retype Password:
* First Name:
Middle/Initial:
* Last Name:
* Gender:
* Birth Date: / /
* Race/Ethnicity American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other
I do not wish to self-identify.
* Home Address:
* City:
* State:
Province (Foreign)
* Zip Code: -
* Home Phone:
Fax:
* Email (Business):
Email 2 (Home):
Countries visited:
Spouse's Name
Would you like FMC to CC your assistant on email communications? Yes
No
Assistant First Name
Assistant Last Name
Assistant Phone
Assistant Email
Are you based in or do you travel frequently to the Washington, DC area? Yes
No
Are you currently a registered lobbyist? Yes
No
Which chamber(s) did you serve in?
(select all that apply)
House of Representatives
Senate
Party Affiliation:
(Select all that apply)
Democrat
Republican
Independent
State/Territory Represented
In which Congress did you first serve?
What was your first year in the House of Representatives?
What was your last year in the House of Representatives?
(If you served non-consecutive periods in office,
please enter the final year of your first period in office.)
If you served non-sequential periods in the House of Representatives,
in what year did you return?
If you served non-sequential periods in House of Representatives,
in what year did you leave again?
What was your first year in the Senate?
(Leave blank if you did not serve in the Senate.)
What year did you leave the Senate?
Committees served on:
(Please check all that apply)
House Agriculture
House Appropriations
House Armed Services
House Budget
House Education and the Workforce
House Energy and Commerce
House Ethics
House Financial Services (Banking)
House Foreign Affairs
House Administration
House Homeland Security
House Judiciary
House Natural Resources
House Oversight and Government Reform
House Rules
House Science, Space, and Technology
House Small Business
House Transportation and Infrastructure
House Veterans' Affairs
House Ways and Means
House Permanent Select Intelligence
Senate Agriculture, Nutrition, and Forestry
Senate Appropriations
Senate Armed Services
Senate Banking, Housing, and Urban Affairs
Senate Budget
Senate Commerce, Science, and Transportation
Senate Energy and Natural Resources
Senate Environment and Public Works
Senate Finance
Senate Foreign Relations
Senate Health, Education, Labor, and Pensions
Senate Homeland Security and Governmental Affairs
Senate Judiciary
Senate Rules and Administration
Senate Small Business and Entrepreneurship
Senate Veterans' Affairs
Senate Indian Affairs
Senate Select Committee on Aging
Senate Select Committee on Ethics
Senate Select Committee on Intelligence
Joint Economic Committee
Joint Committee on Printing
Joint Committee on Taxation
Joint Committee on the Library
Did you serve in a leadership office?
(Please select all that apply.)
Speaker of the House
House Majority Leader
House Minority Leader
House Majority Whip
House Minority Whip
Senate President pro tempore
Senate Majority Leader
Senate Minoirity Leader
Senate Majority Whip
Senate Majority Whip
Other (please specify in next field)
Did you serve in any other
elected or appointed positions? (Please select all that apply.
If "other," please specify in next question.)
Attorney General
Secretary of Agriculture
Secretary of Commerce
Secretary of Defense
Secretary of Education
Secretary of Energy
Secretary of Health and Human Services
Secretary of Homeland Security
Secretary of Housing and Urban Development
Secretary of Labor
Secretary of State
Secretary of the Interior
Secretary of the Treasury
Secretary of Transportation
Secretary of Veterans Affairs
Governor
Lt. Governor
State Senator/Representative
Mayor
City Council
Other (please specify in next field)
Did you serve in any other federal,
state, or local offices not listed above? Please specify.
Are you a current or former Ambassador? Yes
No
If you are or were an Ambassador,
where are or were you posted?
Working languages spoken:
(Select all that apply)
Arabic
Cantonese
French
German
Italian
Japanese
Mandarin
Russian
Spanish
Turkish
Other (please specify in next field)
If you selected "other," please specify
what other working languages you speak:
Colleges/Universities attended:
Colleges/Universities attended:
Colleges/Universities attended:
If you served in the U.S. Armed Forces, which branch did you serve in?
Additional information from your military career:
In addition to general congressional and political matters,
which domestic topics would you feel comfortable discussing?
Budget
Campaigns/Campaign Finance Reform
Civil Liberties
Civil Rights
Cyber-security
Economic Issues
Education
Energy
Environment
Financial crisis
Healthcare
Homeland security
Immigration/Integration
Job creation/unemployment/workforce training
Media
Military
Privacy
Science and Technology
Size of the federal government
Social Issues
Social Security/Medicare/Medicaid
Taxes
Other (please list in next field)
Other domestic issues you would be comfortable discussing
which are not listed above:
Which international issues would you feel comfortable discussing? Arab Spring
Democracy building/Corruption prevention
European Union/Eurozone
Former Soviet Union and Former Soviet Satellite Republics
Global finance
Global security
Global trade
Human rights
Middle East/North Africa
NATO
Nuclear proliferation/Arms control
Strategic military partnerships
Transatlantic relations
Transpacific relations
U.S.-China relations
U.S.-German relations
U.S.-Japan relations
U.S.-Turkey relations
United Nations
World Bank/IMF/Foreign Aid
Other (please list in next field)
Other international issues not listed above
which you would be comfortable discussing:
What boards of other organizations
or foundations do you sit on?
If you are interested in international travel with FMC,
what is your region of choice?
Australia and Pacific Islands
East and Southeast Asia
Eastern Europe
Europe
Former Soviet Satellite Republics
Indian Subcontinent
Latin America
Middle East/North Africa
South America
Sub-Saharan Africa
Are you interested in participating in the Congress to Campus
program,which sends bipartisan pairs of Former Members of Congress
to directly engage with today's youth
to increase civic literacy and participation?
Yes
No
Are you interested in playing in the
Annual Congressional Charity Golf Tournament
to benefit the Wounded Warrior Disabled Sports Project?
Yes
No

Annual Membership Fees
* Membership: Patron of the Association ($10,000)
Benefactor of the Association ($5,000)
Sponsor of the Association ($2,000)
Friend of the Association ($1,000)
Member of the Association ($250)
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