This Application is for an annual membership in FNGLA

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

  Member Company (1 Voting contact - Full Member Benefits for all employees)
  Less than $500,000 Gross Sales $370
$500,001 to $2,000,000 Gross Sales $530
$2,000,001 and up Gross Sales $790
Company Name:  
Company Email: (Used for advertising your company in our
Online Locator, Tradeshows, etc.)
Company Website:
Recommended By: (Please include name and company)

  Supportive Individual (Greenline Newsletter, Ben's Bullets - No Voting Privileges, Service Benefits or Company listings)
  Government Employee List Agency: $95
  Instructor  List School: $95
  Retired horticulturist   $95

*Contact Information

  Title   First Name Last Name Suffix
*Direct Email: (Used only by FNGLA Staff and Chapters Representitives
- Never Shared)

*Address Information

*Street Address:
and/or PO Box:
*County: (Used in determining your initial Chapter placement)
Toll Free Phone:
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
Secondary Business Type:     Optional
Third Business Type:     Optional
(Information for National Horticulture Foundation)
If you are a Citrus Nursery , Please specify: Retail  /    Seed  /    Budwood
(Information for FNGLA's Website or Consumer Website,
Please specify: Commercial and/or Residential

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)
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