Organizational Membership Registration

Type of Organizational Membership

Organizational Membership - With budgets over $200,000- enter $75

Organizational Membership - With budgets under $200,000- enter $50

I want to increase the impact of my membership with an added donation of:

Today's Date *

First Name *

Last Name *

Organization *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Date *

To proceed to secure credit card check out, click continue.

Please be advised that although PayPal is a credit card processor you do not need to create a PayPal account. After inputting your personal information, click next to proceed to the credit card checkout.

A copy of the official registration and financial information may be obtained from the Division of Consumer Services by calling 1-800-HELP FLA within the state. Registration does not imply endorsement, approval or recommendation by the state.