|FTAA Membership Application|
Information provided in this application is for FTAA only
You may use online application form: https://na1.documents.adobe.com/public/fs?
Or print the form below, fill and mail to us.
Please inform us if information listed on your application changes Please feel free to skip those questions you prefer not to answer (all starred questions must be answered) Please make your check payable to FTAA (please do not mail cash) and mail your check and application to: FTAA, 3020 NE 32nd Avenue, Suite 123, Fort Lauderdale, Florida 33308
email: firstname.lastname@example.org FTAA is a non-profit [501 (c) (3)] organization and your membership fees/donations are tax deductible!
(*) First & Last Name: ____________________________________________ (*) Mailing address: ___________________________________________
(* )Apt/Suite#:_________ (*) City: ______________________________ (*) State: _________ (*) Zip: __________ (*) Home Phone #: _______________________ (*) Fax #: _______________________ (*) Cell phone # : _________________________ (*) Work#: ______________________ (*) E-mail: ________________________________________________________________________ Occupation: ________________ Company name: _____________________________ Do you own or partner in the company you listed above (circle one):
Yes/ No/ N/A
(*) Would you work in FTAA committees/can we contact you (circle one): Yes/ No/ Undecided
(*) Spouse Name: ________________________
(*) Children’s Names/Ages: ______________________
(*) Spouse E-mail: _________________________ (*) Spouse Cell #: _____________
(*) Would your spouse work in FTAA committees/ can we contact her/him (circle one): Yes/ No/ Undecided
Do you reside in South Florida (circle one):
Year-Around Winter-Season Just-Visiting
How long have you lived in South Florida:________
How long have you been in the US?: ________
(*) Provide two FTAA member’s names as reference; Name:_________________________________________ Tel:______________,
(*) Have you ever been a member of an illegal organization in USA or in Turkey (circle one): Yes / No
MEMBERSHIP FEE: Membership Type (circle one below) Renewal New member
Membership fees (circle one below) Single (1 year): $60 Single (3 years): $125 Family (1 year): $100 Family (3 years): $250 Student (1 year): $10 Student (3 years): $25
(*) Membership fee paid: $_____, Donation: $______, Total enclosed: $_______
(*) Payment method (circle one): Cash, Check (and check # if paid with a check), PayPal. Check No: ____________
Note: If method of payment is by PayPal, the convenience fee is %3 (min. $5). Please add this to your amount, shown below.
Not: Komisyon %3 (min. $5) olup, işlemin geçerli olması için aşağıdaki tutara tarafınızdan ilave edilmesi gerekmektedir.
The information I provided on this application is true and correct.
All information I provided above is true and correct. I understand that my membership will be voided, in case of any wrongful information.
(*) Signature: _______________________________ (*) Date: __________________
———————————————————————————————————— Office use: ________________________________________________________________________