2015-2016 FASD ASSOCIATE MEMBERSHIP APPLICATION
Associate Member Name:
Date:
Website:
*Services/Products Provided (very important for marketing purposes):
Company Profile for website (for Benefactor Plus Level and above):
Membership Level Requested for 2015-2016 (please circle one):
Supporter
Benefactor
Benefactor Plus
Premier
President’s Level
Corporate Sponsor
Amount Due for 2015-2016: ______________ (Please Choose From the Dues Schedule Provided
Based on Membership Level)
Optional Donation to the Virginia Cebula Scholarship Fund: $_______________
This year the Board has renamed the scholarship fund after Past President Virginia Cebula who was the
driving force behind the creation of the education program that created the CDM program. There is a
minimum donation of $100 and if you donate one full scholarship ($1200), receive recognition as a
Scholarship Sponsor on our web site, at the Annual Conference, the Legislative Forum and a plaque for
your office!
Please Remit to:
Florida Association Of Special Districts
2713 Blairstone Lane
Tallahassee, FL 32301
Please fill out the information below:
The Manager is the primary person you want to communicate with FASD. That person will receive all
Associate Member emails, the Focus Newsletter and will have voting rights.
Each member company can have up to eight other people that are affiliated with your company who can
receive informational emails and the Focus Newsletter. All persons affiliated with your company will receive
the member price for any meeting, including the Annual Conference.
Manager Contact Information:
First Name _________________________
Last Name ___________________________
Title ________________________________
Work Address ______________________________________________________
City, State, Zip
____________________________________________________________________________________
Phone: __________________________ Fax: __________________________
Email _________________________________________________________________________________
First Name _________________________
Last Name ___________________________
Title ________________________________ Elected Official Y/N
Work Address ______________________________________________________
City, State, Zip
____________________________________________________________________________________
Phone: __________________________ Fax: __________________________
Email _________________________________________________________________________________
First Name _________________________
Last Name ___________________________
Title ________________________________ Elected Official Y/N
Work Address ______________________________________________________
City, State, Zip
____________________________________________________________________________________
Phone: __________________________ Fax: __________________________
Email _________________________________________________________________________________
First Name _________________________
Last Name ___________________________
Title ________________________________ Elected Official Y/N
Work Address ______________________________________________________
City, State, Zip
____________________________________________________________________________________
Phone: __________________________ Fax: __________________________
Email _________________________________________________________________________________
First Name _________________________
Last Name ___________________________
Title ________________________________ Elected Official Y/N
Work Address ______________________________________________________
City, State, Zip
____________________________________________________________________________________
Phone: __________________________ Fax: __________________________
Email _________________________________________________________________________________
First Name _________________________
Last Name ___________________________
Title ________________________________ Elected Official Y/N
Work Address ______________________________________________________
City, State, Zip
____________________________________________________________________________________
Phone: __________________________ Fax: __________________________
Email _________________________________________________________________________________
First Name _________________________
Last Name ___________________________
Title ________________________________ Elected Official Y/N
Work Address ______________________________________________________
City, State, Zip
____________________________________________________________________________________
Phone: __________________________ Fax: __________________________
Email _________________________________________________________________________________
DUES SCHEDULE FOR 2015-2016 ASSOCIATE MEMBERS
Supporter-$500
• Eligible to receive Newsletters, and all mailings of legislative and agency updates
• Eligible for Board of Directors
• Attendance at membership meetings and Annual Conference at member fee
• Listed as member on FASD Web Site
Benefactor-$1,000
• All Supporter benefits plus:
• Quarter page advertisement in Newsletter for 1 year
• Company logo with link on FASD Web Site
Benefactor Plus - $2500
• All Benefactor benefits plus:
• Company profile on FASD web site
• Silver Sponsor at Annual Conference includes all sponsorship benefits
• Two free registrations at one quarterly membership meeting during the membership year
Premier -$5,000
• All Benefactor Plus benefits plus:
• Listed as sponsor of one full Certified District Manager Scholarship
• Listed as co-sponsor for one food function at Annual Conference
• Special designation on FASD web site
• 1 article in Newsletter (not an infomercial)
• Two free registrations at all, not one, quarterly membership meetings during the membership year
• Special plaque designating level of membership and years at that level
President’s Level -$10,000
• All Premier benefits plus:
• Listed as sponsor of two, not one, full Certified District Manager Scholarships
• Listed as Gold, not Silver, Sponsor at Annual Conference
• Listed as Silver Sponsor for the Legislative Forum (includes all sponsorship benefits)
• Half, not quarter, page advertisement in Newsletter for 1 year
• Four, not two, free registrations at all quarterly membership meetings during the membership year
• One speaking engagement (not infomercial) at a member meeting
Corporate Sponsor -$25,000
• All President’s Level benefits plus:
• Listed as sponsor of three, not two, full Certified District Manager Scholarships
• Listed as Platinum, not Gold, Sponsor at Annual Conference
• Listed as a Gold, not Silver, Sponsor for the Legislative Forum (includes all sponsorship benefits)
• Listed as sole sponsor for one food function at Annual Conference
• One speaking engagement (not an infomercial) at the Annual Conference
• Full, not half, page advertisement in Newsletter for one year