Application

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Sponsor: A Name Must Be Entered

Application Date: Date Required

Occupation: Please enter your occupation

E-Mail: E-Mail Required

Company Name:

IMDB #:

Address: Please enter your address

City: City Required

Zip: Valid Zip Required

TELEPHONE Work: Work Nbr required

Cell: Cell nbr required

State:

First: Name Required

NAME Last: Name Required

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Membership Applied For:

Credit Card Number:

Expiration Date:

Billing Zip:

Auth. Code

Billing Name:

Membership Applied For:

Bus. Individual Name 2:

Bus. Individual Name 3:

Bus. Individual Name 4:

Please review information and click submit to send application to FMPTA. Receipt will be e-mailed to you. We store no financial information.

Membership Applied For:

Membership is approved by FMPTA's Board of Directors, with renewal on an annual basis. Please attach the required information, above, as supportive documentation of your application. Upon acceptance by the Board of Directors, you will receive a receipt and Welcome Letter.

FLORIDA MOTION PICTURE & TELEVISION ASSOCIATION
MEMBERSHIP APPLICATION

This page last modified on Thursday, April 28, 2016