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FSA Membership Application (for printing only)
Title:	Mr. Mrs. Miss Ms.
Name:
Mailing Address:
City, State, Zip:
Phone Number:
Membership Options (check one):     Law Enforcement Affiliation: Company Name:	Honorary member $25 Law Enforcement member $25 Business member (select level)            BRONZE $50            SILVER $250            GOLD $500
*Annual Dues
In addition to my dues, I also wish to purchase auto tags at $10 each
Please enter the appropriate sales tax amount for your county (applies to auto tags only):
*In addition to my dues, I am enclosing a donation to the Florida Sheriffs Youth Ranches, Inc.
TOTAL:
Method of Payment:	Visa Mastercard Check
Account Number:
Expiration Date:

Please fill out and print the above application and mail to the following address:

Florida Sheriffs Association
P.O. Box 12519
Tallahassee, FL 32317