Organization Membership

(includes four individual memberships)

If you have already registered on this site before, please login before completing the membership form.

Terms:

$100 / Year

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Email:* Email is Required

Phone:* Phone is Required

Title:* Title is Required

Organization:* Organization is Required

Organization/School Contact:* Organization/School Contact is Required

Organization Email, if different: Organization Email, if different is not valid

Organization Phone, if different: Organization Phone, if different is not valid

County: County is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Pay by Credit Card: VISA, Mastercard, Discover only. (AMEX not accepted.)

Pay with your credit card via Authorize.net

Pay by Cash or Check

To pay, please mail your payment to:

1033 N.W. 6th Street, Suite 101
Fort Lauderdale, Florida 33311

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