Date: ________________________________________
Name: ________________________________________
Certification: CLA ( ) ALS ( ) PLS ( ) Other ________
Home Address: ________________________________
______________________________________________
Employer: ____________________________________
Business Address: _____________________________
______________________________________________
Your Title: ____________________________________
______________________________________________

PREFERRED MAILING ADDRESS:
HOME ( ) BUSINESS ( )
Telephone:
HOME (____) ______________________________
WORK (____) ______________________________
FAX (____) ________________________________
E-MAIL ___________________________________
Birthday Month:________________Day:_____________

Your Specialty:
Administrative/Government
Bankruptcy
Corporation/Business Law
Criminal
Entertainment
Environmental
Family
Law Office Management
Litigation
Mediation
Probate/Estate Planning
Real Estate
Taxation
Utility
Workers’ Compensation
Other:

Type of Law Office:
Private Law Firm
Corporate Legal Department
Government Legal Department
Court System
Court Reporter’s Office
Self-Employed
Other:

HOW DID YOU LEARN OF THIS ASSOCIATION?
Name:
Chapter:
SPONSOR (if any):______________________________

MEMBERSHIP CATEGORIES
(BI-LEVEL ORGANIZATON)
STATE - FALSS:

$10 One-Time Initiation Fee – FALSS
AND ONE OF THE FOLLOWING LEVELS:
$30 Individual Member - FALSS
$15 Retired Member - FALSS
$15 Student Member - FALSS
(no Initiation Fee for Students)

AND LOCAL – SMALSS:
$20.00 Individual Member - Local Chapter
$10.00 Retired Member - Local Chapter
$10.00 Student Member - Local Chapter

_____$ Total State & Local Dues

[Dues for members joining FALSS/SMALSS
during the period January 1 through March 31
shall be as follows:]
A. Voting/Individual Member
FALSS: $45.00 (1.5 yrs.)(+$10 Initiation Fee)
SMALSS: $30.00 (1.5 yrs.)
B. Retired Member
FALSS: $22.50 (1.5 yrs.)(+$10 Initiation Fee)
SMALSS: $15.00 (1.5 yrs.)

Return this form and your check payable to:
SMALSS Treasurer
PO Box 328
Sarasota, FL 34230-0328

Method of Payment:
Check Cash Money Order
Do not send cash in the mail.

APPLICANT’S SIGNATURE:

_________________________________________

FOR MORE INFORMATION:
SMALSS Headquarters
Vice President/Membership Chairman
PO Box 328
Sarasota, FL 34230-0328
www.smalss.com

OR
FALSS, Inc.
Attn: Vice President/Membership Chairman
Association Headquarters,
P.O. Box 161390
Altamonte Springs, FL 32750-1390
www.falss.org