Membership Application – Florida Phosphate Political Committee

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Name(Required)

Title(Required)

Company(Required)

No. Employees(Required)

Company Line of Business(Required)

Address

Business Telephone(Required)

Cell Phone(Required)

Contact Email Address(Required)

Additional Contact Email Address(Required)

Please Check Membership Type:

Silver Membership - $600 Annually

Gold Membership - $1,200 Annually

Platinum Membership - $5,000 Annually*

Please calculate your membership dues using the table below. If paying by card, upon hitting "submit" you'll be directed to a form where you can pay your membership dues.

Payment Method(Required)

Please mail checks to:

Carroll & Company, CPA's
Attn: Parker Copeland
2640A Mitcham Drive
Tallahassee, FL 32308

Help us track your purchase. If you know the check number, enter it below

*(Eligible for FPPC Board Membership and Invitation to Special and/or Private Meetings and Events)

Billing Cycle: Calendar Year - Jan 1 to Dec 31

Dues invoiced annually in January