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Dues categories are based on Florida-based annual revenue from pest management work performed in the general household pest, wood destroying organism (termite), lawn care, wildlife control, fumigation and all other certification categories.

Name:

Nickname:

DACS Certificate #

Company Info:

Address:

City:

State:

ZipCode:

County:

Phone:

Fax:

E-mail:

Website:

Certified in:
GHP    L&O Termite Fumigation
Date Business Started:
Number of Employees:

ACTIVE MEMBER:

Pest control company actively engaged in the pest control industry in Florida (licensed by appropriate State Agency under Chapter 482, Florida Statutes). Entitled to one voting representative for each registered office or branch.

BRANCH OFFICE(S):

A firm may register additional branches or separate offices for mailing and voting privileges at no additional charge. Attach a list of ALL offices and branches listing contact person, company name, address, telephone, fax and e-mail.

COMMUNICATIONS AGREEMENT: I understand that by providing my mailing address, e-mail, telephone numbers, and fax number, I consent to receive communications via these means from FPMA

Dues to FPMA are not deductible as charitable contribution but may be deductible as an ordinary and necessary business expense. A portion of dues, however, is not deductible as an ordinary and necessary business expense to the extent that FPMA engages in lobbying. The non-deductible portion of dues for 2007 is 12%.

I would like to join other Florida Pest Management Association professionals and I agree to adhere to the Association’s Code of Ethics. I understand that membership is not effective until official notification.

SIGNATURE: