FLORIDA ASSOCIATION OF COUNTY AGRICULTURAL AGENTS
2008-2009 Membership Form

NAME: 

ADDRESS: 

CITY:  ZIP:

TELEPHONE:  EMAIL: 

FAX:  COUNTY:  FACAA DISTRICT: 

TITLE:  I II III IV

SPECIALTIES (Please Check)

4-HYouth Administration Aquaculture Crops Dairy Economic Development Engineering
Forestry
General Horticulture IPM Livestock Management Natural Resources
Water Quality Other (Please List):  

Full Dues $100.00 (Includes NACAA Dues) - Payment by Check
Full Dues $103.30 (Includes NACAA Dues) - Payment by Credit Card through PayPal
New Extension Agent or Specialist - Employed after July 31, 2008 and never before held FACAA 
memberships - FREE - Date of Employment:

Life Member $50.00 (For Retired Extension Agents/Specialists only.)  One time only payment (does not include subscription to County Agents Magazine).
My Check is Enclosed and Payable to:  FACAA
(Send check with this membership form to address below.)
I have used PayPal to pay by Credit Card.  Click on icon below:

IMPORTANT:  Send check with this completed membership form and/or if paying by credit card through PayPal, send the completed membership form to:

Gerald R. Edmondson - FACAA Treasurer
5479 Old Bethel Road - Crestview, Florida 32536-5512
(850) 689-5850
DUES POLICY:  Dues are due prior to the EPAF Annual Meeting and are delinquent after December 31, 2008.  To insure consideration for awards, recognition, abstracts, scholarships and other programs of the association, annual dues MUST be postmarked by December 31, 2008.

FACAA FEDERAL TAX I.D. NUMBER:  59-2228957