ORDER FORM / MEMBERSHIP APPLICATION

   

First Name:

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Last Name:

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Email Address:

Affiliation:

Address:

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City:

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State:

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Zip Code:

 -*

Phone Number:
Fax Number:
Local Chapter:
   
MEMBERSHIP APPLICATION INFORMATION
   
List additional names as applicable for Agencies or Organizations
1.
2.
3.
   
List additional names as applicable for Elected or Appointed Board Members
   
1.
2.
3.
4.
5.

DUES

To join the Florida Planning and Zoning Association, identify a Chapter containing your location on the list at left. Refer to the current list of Chapter Dues below to determine the appropriate dues amount. These amounts include both State and Local dues.
   
Chapter Individual Agency / Organization Planning Boards
Apalachee $55 $125 $125
First Coast $80 $170 $170
Springs $55 $125 $125
Surfcoast $70 $170 $170
Central Florida $65 $160 $160
Suncoast $65 $140 $140
Gulfcoast $60 $135 $135
Gulfstream $60 $145 $145
Calusa $60 $130 $130
South Florida $55 $120 $120
Heartland $55 $120 $120
Suwannee $55 $120 $120
Northwest $55 $120 $120
     

• Agency / Organizational membership may have a maximum of three individuals. Elected / Appointed Planning Board may have a maximum of five individuals. Include these names with the attached application form for them to receive all the FPZA benefits.
• Full-time Students may utilize a Student Membership and may join at a dues rate of $5.00 per individual. Include student identification with this application. (First Coast Student dues are $15.00 per individual.)
• Sustaining Members, wishing to increase their financial support of FPZA, may increase individual dues to $100.00.
   
FPZA DUES: $
   
AVAILABLE ITEMS
QTY SIZE   PRICE
Ladies Stretch Poplin $37.00
Ladies Scoop Neck Shirt $21.00
Ladies Sport Polo Shirt $28.00
Ladies Fleece Jacket $38.00
Men’s Buttoned-Collar Shirt $34.00
Men’s Sport Polo Shirt $28.00
Men’s Fleece Jacket $38.00
Men’s Golf Shirt $20.00
Ball Cap $16.00
Attaché Case $20.00
       
BILLING INFORMATION
Name on Card:
Card #:  
Verification Code:  
Expiration Date:  
Billing Address:  
Billing City:  
Billing State:  
Billing Zip: -