INVOICE

2007 Membership Dues

   Name of Individual/Organization: _________________________________________

    Organization Contact: ___________________________________________________

     Address: _____________________________________________________________

     City/Zip Code: ________________________________________________________

     Email: _______________________________________________________________
                                                                        Please print

     Phone (H): ___________________________________________________________

     Phone (W): ___________________________________________________________

     Fax: _________________________________________________________________

       * * * * * * * * * * * * * * * * * * * * * * *
Circle one:
            Statewide Organization      Local/Regional Organization             Individual
                Dues $125.00                          Dues $40.00                                    Dues $25

Make check payable to:   FWC
Mail dues check to:  
Sue Banks, Treasurer
4335 Elm Avenue
Palm Beach Gardens, FL 33410

Website:  http://www.floridawomensconsortium.com

 

2007 Lobby Days and Annual Meeting
March 18-20, 2007
Holiday Inn Select
Tallahassee