VIEWS: 3 PAGES: 1 POSTED ON: 9/16/2012
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 APPLICATION FORM Dear Member: Thank you for your interest in joining FEPA. Please complete this application 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 APPLICATION 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 email@example.com 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!
Pages to are hidden for
"Florida Emergency Preparedness Association"Please download to view full document