FNGLA Membership Application

This Application is for an annual membership in FNGLA

Please note all fields with * are required.
You may Click Here for a printable application.

  Organizational Membership (1 Voting contact per Full Member - All employees are Member Benefit Recipients)
  Full Member - Gross Sales Less than $500,000 $370
  Full Member - Gross Sales $500,001 to $2,000,000 $530
  Full Member - Gross Sales $2,000,001 and up Gross Sales $790
  Supportive Member - Not for profit (Government, Education, etc.) $95
     
Company Name:  
Company Email:    
Company Website:    
   

  Individual Membership (Greenline Newsletter, Ben's Bullets - No Voting Privileges, Service Benefits or Company listings)
       
  Student  List School: $75
  Retired Industry Professional   $95

*Contact Information

  Title     First Name Last Name Suffix
   
*Direct Email: (For FNGLA Staff and Chapters Representitives only)

*Address Information

*Street Address:
and/or PO Box:
*City:
*County: (Used in determining your initial Chapter placement)
*State:  
Country:
*Zipcode:
*Phone:
Toll Free Phone:
Fax:
 
Please select your Primary Business Type or Segment
*Primary Business Type:   (Used for determining your Division placement)
 
Please select your Other Business Types or Segments (Optional)
Secondary Business Type:     
Third Business Type:    
     
(Information for FNGLA's Website or Consumer Website, www.floridagardening.com)
Please specify: Commercial and/or Residential
 
How did you learn about FNGLA?
  From social media posts like Facebook, Twitter, Linkedin, etc.
  A friend/industry colleague  
  Other - Please explain    
 

FNGLA-PAC Contribution (Optional)

Voluntary FNGLA Political Action Committee Contribution:   
(Suggested Donations: $500 $250 $100 $50 Other)  

Payment Information

*Card Type:
* Credit Card Number:
*Credit Card Expiration Date: /20
*Credit Card CVV: What is a CVV?
*Cardholder's Name:
*Cardholder's Phone:
*Cardholder's Email: (Required for transaction confirmation)
   
Credit Card Billing Address: *(If different from that of above)
Address:
City:
State:
Zipcode:
 
Please read and check both boxes below
 
*Membership Agreement: *In applying for membership, I agree to abide by the Association Code of Ethics. I certify that the information contained herein is true and correct to the best of my knowledge and that any information found to be false may be grounds for denial of membership or removal of membership.
*Credit Card Approval: *I authorize FNGLA to process my credit card for Membership as specified on this form.
* Enter this Verification Code 705533 :
   
 
Questions or comments?
Contact: Toni Wise
Phone: 800.375.3642
EMail: twise@fngla.org