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The Florida Association of Legal Videographers, Inc.

Post Office Box 17048, Clearwater FL 33762-0048

Office Phone/ Facsimile 727-539-7511

Membership Application

Name: ______________________________________________________________________

Mailing Address: ____________________________________________________________

City/State/Zip _______________________________________________________________

Home Phone: ( ) ___________________________

Office Phone: ( ) ___________________________

 

FAX: ( ) ___________________________

E-Mail Address: ________________________________ wEB SITE:________________________

NAME OF YOUR Company: ________________________________

EMPLOYED BY: ________________________________

Years Involved in Legal Videography:_______

REFERRED BY (IF APPLICABLE): ____________________

I, _____________________________________, Have Enclosed my Check or Money Order

Signature

(Made payable to The Florida Association of Legal Videographers, Inc) In The Amount of $12.00 For My One Year Membership Dues. please forward to the associations address above.

Note: The Board of Directors reserves the right to accept or deny membership application. If denied your full membership DUES will be refunded.

Membership belongs to the registered individual and is non-transferable