Membership Checkout

Membership Level change

You have selected the Premium Membership membership level.

The price for membership is $575.00 now.

Membership expires after 1 Year.

Account Information Already have an account? Log in here

Are you a current FAC Member *

Username

Password

Confirm Password

E-mail Address

Confirm E-mail Address

Full Name LEAVE THIS BLANK

Primary Membership Information

Primary Contact *

Name of Law Office, Agency, or Business *

Primary Email ( used for List Server) *

Type *

Please Specify Other

Street Address

Street Address *

Street Address Line 2

City *

State *

Zip *

Mail Address

Is your street address and mailing address the same?

Yes

Street Address

Street Address Line 2

City

State

Zip Code

Misc_section

Office Phone *

Fax Number

Your Website

Florida Bar #

Florida License #

State(s) Where Licensed

Services Provided *

Florida Regions *

Specify other services

Have you ever been convicted of a crime, or do you now have any criminal charges pending against you other than minor traffic violations?

Yes

If YES to the above question then please explain below

Have you ever been professionally disciplined, or do you now have pending any matter regarding renewal, revocation, or suspension of your license?

Yes

If YES to the above question then please explain below

Have you ever been sued by a client, or do you now have pending against you any claims by a client?

Yes

If YES to the above question then please explain below

Total Years As Licensed Attorney or Other Adoption Professional

Colleges/Universities Attended, Dates, and Degree(s) Obtained

Publications

Honors and Awards

Professional/Civic Organizations (Include Offices Held)

Acknowledgment & Payment Section

I have read and agree to the FAC Listserv policies. *

Acknowledgment

By checking this box, I also acknowledge that I have read, received, and retained a copy of the policies for participation in the Florida adoption council's list serv (revised March 2019). I have also reviewed the said policies with each member of my office staff. I will maintain a copy of said policies at all times and personally insure that any postings to the list serv by me, or by any member of my office, comply with said policies. Regarding participation in, and use of information shared on the list serv, I understand that use of the list serv is a privilege, and that any failure by me, or by any member of my staff, to comply with said policies will constitute grounds for immediate suspension or permanent revocation of my access to the list serv. I further understand that it may also be grounds for immediate suspension or revocation of my Florida adoption council membership. I agree to indemnify and hold harmless the Florida adoption council, including its directors, from any liability resulting from any list serv postings, or comments, made by me or by any member of my office staff. *

Certification

By checking this box, I hereby swear, affirm, and certify that the statements in this initial membership application are true and correct. I understand and agree that submitting this application for membership does not necessarily mean that the board of directors will approve my application and grant membership. I further understand and agree that my being granted membership in, and being permitted to remain a member of, the Florida adoption council is within the sole absolute discretion of the organization's board of directors, and that its decision is final. *

Signature

Clear

Title *

Billing Address

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Payment Information We Accept Visa and Mastercard

Card Number

Expiration Date /

Security Code (CVC) (what's this?)

Processing...

Please login to renew or upgrade your account.

Membership Level change

Account Information Already have an account? Log in here

Primary Membership Information

Street Address

Mail Address

Misc_section

Acknowledgment & Payment Section

Acknowledgment

Certification

Billing Address

Payment Information We Accept Visa and Mastercard

Get in Touch