Florida Sheriffs Association Home Page

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Please print form and complete with the appropriate information then mail it with your check to us at:

Florida Sheriffs Association
P. O. Box 12519
Tallahassee, Florida 32317-2519

FSA Membership Application
Title:	Mr. Mrs. Miss Ms.
Name:
Mailing Address:
City, State, Zip:
Phone Number:
Membership Options (check one):	Honorary member $20 Law Enforcement member $20 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:
Account Name:
Expiration Date:

Is this a business membership? If so, please provide the following:
Business name:
Name of contact:
Title of contact:
Company Type:	Single Proprietorship Partnership Corporation
Year Started:
Description of business:
Is this a law enforcement membership? If so, please provide the following: Law Enforcement Agency: