Florida Surveying and Mapping Society

2015 Dues INVOICE & MEMBER DATA SHEET Membership Year 01/01/15 to 12/31/15

SUSTAINING FIRM Member

(Please make needed corrections or additions to information below.)

Firm:

Contact Name:

LB#:

Address:

Tel:

Email:

Chapter:

County of Residence:

District:

Website:

DUES: AMOUNT:

2015 STATE DUES
(If paying by check, deduct $8.00 from your state
membership fee, $258-$8= $250) / ______
2015 CHAPTER DUES / ______

Voluntary Contributions/Membership:

Disaster Relief Fund

/ ______
Scholarship Fund
/ ______
FL GPS User’s Group Membership Dues - $25.00 / ______
TOTAL ENCLOSED: / ______

You may pay your state dues on an installment plan of 4 payments; however, your Chapter dues must be paid in full with the first installment payment and all payments must be received before September 30, 2015. You may also pay your state dues on a monthly plan; however, your Chapter dues must be paid in full with the first installment payment and all payments must be received before September 30, 2015. Your annual dues will be divided into 9 monthly payments and automatically charged to your credit card on the 15th of each month.

Payment Information: ____ Check Enclosed (Payable to FSMS) ____ VISA/MasterCard/American Express
Card Number: ______Expiration Date: ______
Credit Card Billing Address: ______
Signature: ______

The Omnibus Budget Reconciliation Act of 1993 requires associations to inform their members of the amount of dues used for lobbying and political purposes. This lobbying amount is not deductible by you as a business expense on your personal or business tax returns. Of your dues payment, 25 percent is used by Florida Surveying and Mapping Society, Inc., for lobbying and protects your right to practice in the field of surveying and mapping.

Chapter Dues:

Broward = $35 / Emerald Coast = $20 / Miami-Dade = $50 / Ridge = $25
Central Florida = $30 / Florida Crown = $30 / North Central Florida = $35 / Space Coast = $25
Charlotte Harbor = $25 / Gulf Coast = $25 / Northwest Florida = $20 / Tampa Bay/West Central = $40
Chipola Area = $25 / Indian River = $25 / Palm Beach = $50 / Volusia = $30
Collier-Lee = $20 / Manasota = $35 / Panhandle = $40

IF PAYING BY CHECK, MAIL INVOICE AND CHECK TO: FSMS, P.O. Box 850001-243, Orlando, Florida 32885

IF PAYING BY CREDIT CARD, FAX OR EMAIL INVOICE TO: 850.877.4852

QUESTIONS? Call 800.237.4384