Associate Membership application here

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