Pot of Gold Account Info Form

1
What is your name?* This field is required.
First Name
Last Name
2
Do you have a child under the age of 12?* This field is required.Children must be 12 years or younger to be eligible for Pot of Gold Club Membership.
YESNO
3
How did you hear about our Pot of Gold promotion?* This field is required.
FFCU Website
Facebook
Email
Radio
Outdoor Sign
Employee / Friend
4
What is a good phone number for us to reach you at?* This field is required.A Member Services Representative will be in touch with you as soon as possible.
Area Code
Phone Number
Should be Empty: