2011 Annual Dues Invoice

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					       Florida Extension Association of Family & Consumer Sciences

                                2011 Annual Dues Invoice
                                for January 1 - December 31, 2011
  Dues must be received by December 15, 2010 to be an eligible candidate for FEAFCS Professional Awards



                                       Active Member $120
                                      Make check payable to: FEAFCS
                        (Florida Extension Association of Family & Consumer Sciences)
              Note: The National portion of your dues will be forwarded by the FEAFCS Treasurer.
               New Agents pay only $70 for National dues, $50 State dues waived the first year.

                          EIN #52-1633990-182300 Tax Exempt #11-06-024056-5TC

                                    Mail the check and this whole page to:
                                      Meg McAlpine, FEAFCS Treasurer
                                Nassau County Cooperative Extension Service
                                 543350 US Hwy. 1     • Callahan, FL 32011
                     Phone: (904) 548-1116 Fax: 904-548-1465 Email: connor@ufl.edu


Please print clearly or type.     Date ____________
Please check one:      ❑ First Time FL Member $70         ❑ Renewing FL Member $120

       ❑ Transfer National Membership from (state) __________ and number of years previously _____ $50
Name ________________________________            Name change? previously: _________________________

Office Address ________________________________________________________________

City _________________________________          FL    Zip_______________        Region: Southern

Office Phone ________________________________              Suncom ________________________________
Fax           ________________________________            Email __________________________________

County __________________         Florida District (circle) NW • NE • Central • S.Central • South • Campus

Home address ________________________________________________________________

City ________________________________           FL   Zip_______________

Home Phone ___________________________                    Mail Reporter Newsletter to: ❑ Office ❑ Home

Please check 3 major areas of programming:

❑ Nutrition    ❑ Food Safety ❑ Financial Mgmt. ❑ Human Development ❑ Parenting Educ.

❑ Child Devel. ❑ Housing ❑ Clothing/Textiles ❑ Community Devel. ❑ Administration ❑ 4-H Youth