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FMAA
Membership Application 2009 |
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_______ Renewal
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_______ New Member
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Name |
__________________________________________________________________________ |
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Street Address |
__________________________________________________________________________ |
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City ST ZIP Code |
__________________________________________________________________________ |
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Phone |
Home ___________________________ |
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Cell ____________________________ |
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E-Mail Address |
__________________________________________________________________________ |
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License Number |
__________________________________________________________________________ |
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Signature & Date |
__________________________________________________________________________ |
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Job Title |
__________________________________________________________________________ |
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Employer |
__________________________________________________________________________ |
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Address |
__________________________________________________________________________ |
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City ST ZIP Code |
__________________________________________________________________________ |
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Work Phone & Fax |
__________________________________________________________________________ |
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E-Mail Address |
__________________________________________________________________________ |
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Annual
Dues : $25.00 Membership is
valid January 1 thru December 31. Members will be included in the
current year’s membership directory if dues are received prior
to March 1.
Please make check payable to FMAA.
Mail check and membership application
to :
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Kathy
DeMent, CMAS
P.O. Box 477
Zellwood, Florida 32798 |
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Tell us in which committee you are interested in volunteering: |
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____ Bylaws
____ Education / Meeting |
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____ Membership
____ Newsletter |
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