Florida Emergency Preparedness Association

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					                                     FLORIDA EMERGENCY PREPAREDNESS ASSOCIATION
                                                      400 Capital Circle SE, ST 18-263
                                                               Tallahassee, FL 32301
                                                                         850-274-1835
                                                                          www.fepa.org

        FLORIDA EMERGENCY PREPAREDNESS ASSOCIATION
               2012 MEMBERSHIP RENEWAL FORM
Dear Member:

Thank you for your continuing support of FEPA and its programs. Please complete this
renewal form for your 2012 FEPA membership dues. Annual Membership dues for the
2012 calendar year are $75.00 per person. Student membership dues are $25.00 per
person.

MEMBERSHIP RENEWAL FORM:

Please provide us with your membership information:

  Name:
  Title:
  Company:
  Address:
  City:                     State:             Zip Code:
  Work Phone:                                  Work FAX------
  Email Address:
  FEPA Area:

To pay using Mastercard/Visa/American Express write the account information and
expiration date below then email to erainey@fepa.org or mail to the address above.

Card # ________________________________          Expiration date ___/____
Security Code: ________ Name as Appears on Card: ___________________
Billing Address of Card: __________________________________________
City: ____________________ State: ______________ Zip: _____________
Pay online at http://www.fepa.org/

  Make check payable to:

  Florida Emergency Preparedness Association, Inc.
  Federal ID # 59-2389989
  400 Capital Circle, SE ST-18-263
  Tallahassee, Florida 32301

                      THANK YOU FOR YOUR SUPPORT!

				
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