Form Type: 
STUDENT CLASSIFICATION:        High School    College   Trade School
BUSINESS INTEREST:        Retail/Sales   Real Estate   Finance/Investment   Marketing/Advertisement    Service
STUDENT - GENERAL INFORMATION
Title/Name:
If applies, only.
Spouse's Title/Name:
Birthday (month/day):
If applies, only.
Spouse's Birthday (month/day):
Expected Graduation:
(m/d/y)   

If applies, only.
Wedding (month/day/year):
CONTACT & MAILING INFORMATION
Home Address:
City:
State:
Zip Code:
Country:
Home Telephone:
Home Fax:
School Name:
School Street Address:
City:
State:
Zip Code:
Country:
School Telephone:
School Fax:
School Mail Address:
City:
State:
Zip Code:
Country:
Email:
Website:
Counselor's Name:
Counselor's Telephone:
  Ext.
Major:
Minor:
STUDENT - DETAILED INFORMATION
How did you hear about us?   TV   Faith Alive Newsletter   Website   Word of Mouth   Other
Are there any other organization(s) with which you are associated?  
Why do you want to become a part of FCM International?  What do you expect to receive?  
Where are your interests in Business or Ministry (i.e., sales, service, management, finance, medical, research, personal development, community development, teacher, preacher, helps ministry, youth/children/adult, music,etc.)?  
What area(s) have you worked in outside of school, on a Volunteer (not for pay) or Outreach basis? 
Name some of your extra curricular activities.
Additional Comments:
METHOD OF PAYMENT
Agreement: I agree to pay the amount selected below in USD. By entering my initials in this box, I authorize this transaction.
Payment:
Charge Amount:
Card Type:
Name on Card:
Card Number:
Card Security Code (CSC):
Expiration Date: Month Year