Please fill out the form below to sign up for FDLA membership or sponsorship. These memberships or sponsorships can be renewed annually.

All fields marked with a * are required:
Prefix* Dr.Ms.Mr.Mrs. Other
First Name*
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Last Name*
Organization Type*
Primary Job Duty*

If you select Other, please specify:

Membership Type*
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County* Country*
Phone* (999-999-9999)
Email Address*
Please, provide any feedback from your experience on signing on to FDLA.
*Click on the Submit button to process your membership (Your membership won’t be activated until your payment is received).
*Please make your check out to FDLA and mail it to: FDLA, c/o Dr. Judith Stein, 1750 NE 167 St. Tech Building, Room 333 North Miami Beach, FL 33162