Florida Cosmetology Association

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MEMBERSHIP APPLICATION

Salutation
Name	(As you want it to appear on your membership card) (Required)
Home Address	(Required)
Home City	State Zip (Required)
E-Mail	(Required)
Home Phone	(please include area code)
Business Name
Business Address
Business City	State Zip
Business Phone	(please include area code)
Business E-mail
Comments	(Required)

Membership Classification (check all that apply)

	Cosmetology			Salon Owner			Nail Tech
	Esthetician			Barber

Membership Dues $60.00
      Student (Student Dues are $45.00)
     Name and complete address of School:

Please Check where you want FCA Mail delivered: Home Business

Professional License Number Year Issued

Application must be accompanied by annual dues payment.

Release Notice:

I understand that dues for FCA are not deductible as a charitable contributions for federal tax purposes. I understand, however, that these dues may be deductible to members for federal income tax purposes as ordinary and necessary business expenses under Section 162 Internal Revenue Code. I understand that no portion of my dues can be refunded once FCA receives payment. I agree to abide by the FCA by-laws currently in effect and any changes that may be made in the future.

I Have Read and Understand the above statements. (Required)

Please print this page for your records before clicking the submit button below.

To Paying By Check or Money Order, Please Send Your Payment To:
Florida Cosmetology Association
4492 Harbour North Court
Jacksonville, FL. 32225
(904) 642-2251
bpoole1234@aol.com
** Please include a copy of this page with your payment