FLORIDA EMERGENCY PREPAREDNESS ASSOCIATION
400 Capital Circle SE, ST 18-263
Tallahassee, FL 32301
850-274-1835
www.fepa.org
FLORIDA EMERGENCY PREPAREDNESS ASSOCIATION
2016 MEMBERSHIP APPLICATION FORM
Thank you for your interest in joining FEPA. Please complete this application form for
your 2015 FEPA membership dues. Annual Membership dues for the 2016 calendar year
are $100.00 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:
Work Phone:
Email Address:
State:
Zip Code:
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
Were you referred to FEPA by a current member?
If yes, please tell us who referred you? _____________________________________
THANK YOU FOR YOUR SUPPORT!