Florida Park Service Alumni Association

Florida Park Service Alumni Association
Membership Application

To apply for membership in The Florida Park Service Alumni Association, please complete the following information. Send the completed application along with a check made out to Florida Park Service Alumni Association, Inc., for the $15.00 annual membership dues to:
Judi Maxwell, FPSAA Secretary
558 S.W. Maxwell Court
Fort White, Florida 32038
(386) 497-4750

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Personal History Information:
NAME: __________________________________________________________________________________
ADDRESS:________________________________________________________________________________
________________________________________________________________________________________
TELEPHONE: (HOME)___________________________ (WORK)___________________________ (Email)_______________
If spouse of Division of Recreation and Parks employee:
Give employee name_________________________________________________years service__________

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Membership Status: (check one of the following)
( )Regular Member
Current, retired or past Division of Recreation & Parks employee who has attained permanent status employment. Spouse of current, retired or past Division employee who is or was previously in a permanent status
( )LIFETIME MEMBER
Regular member who has paid a lump sum equivalent of 20 years of annual dues in advance. Spouses, widows, and widowers of Regular Members are also eligible.
Current or past section or district where employed with the Division of Recreation and Parks:_______________________________________________________________________________

************************USE OTHER SIDE FOR COMMENTS************************* --FOR FPSAA BOARD USE ONLY!
( ) REGULAR MEMBERSHIP ( )Life Membership ( ) NOT ELIGIBLE

_________________________________
Secretary, FPSAA

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