Florida Distance Learning Association

New Membership Application

FDLA is offering memberships for both individuals and institutions.

Type Amount

Individual $35.00

Institutions $300 with up to 15 memberships and
then $25 for each additional membership

Business
$350 with up to 10 memberships and
then $25 for each additional membership

All fields marked with a * are required:

Prefix* Dr. Ms. Mr. Mrs. Other

First Name*

Middle Initial

Last Name*

Organization*

Organization Type*

Position*

Primary Job Duty*
If you select Other, please specify:

Address1*

Address2

City*

State* Zip*

County* Country*

Phone* (999-999-9999)

Fax

Email Address*

Member Suggestions

*Select an option and click on the Submit button to process you payment (Your membership won’t be activated until your payment is received.)

Pease made your check out to FDLA and mail it to:

Barbara Cavanah, FDLA treasurer
362 Stirrup Key Blvd.
Marathon, FL 33050

Individual ($35)
Institutional ($300 with up to 15 memberships)
Business ($350 with up to 10 memberships)