Florida Defense Lawyers Association - Corporate Membership Application

*Indicates required field
* Last Name:
* First Name:
Middle Name:
* Company Name:
* Company Address:
* City:
* State:
* Zip:
* Phone:
Fax:
* Email:
* I am not licensed to practice law.
If so, which state(s):
(Attorneys licensed to practice in Florida are NOT eligible for Corporate Membership. They may be eligible for Individual Membership.)
* Position within company:
* Birth Date: (MM/DD/YYYY)
* Place of Birth: (City, State)
* Degrees Held: (Year of Graduation and School)
* Other professional organizations to which you belong:
* Please describe the type of services provided by your corporation or organization:
* Initiation fee and first annual dues are enclosed (to be refunded if this application is not approved).	Initiation fee - $75.00 Annual Dues Corporate Membership Annual Dues - $125.00 Total Enclosed $
NOTE: When any single company has paid in dues for its members an amount equal to ten times the highest membership class of dues, there will be no initiation fee for additional members and such additional members shall receive a discount of 50% of the dues hereinafter set forth.	I am eligible for this discount. I am NOT eligible for this discount.
Are you interested in any of the following?	Editorial aspect of the Trial Advocate Quarterly Contributing material to the Trial Advocate Quarterly Other(specify):



FDLA is exempt from Federal taxation under IRC 501 (c)(6). Membership dues are not tax deductible as a charitable contribution; they may be deductible as a business expense.

Federal Tax ID Number: 59-2717926