FSGA Individual Membership Form

I. Membership Category (Choose the Membership you would like to purchase): Click here for Organizational Membership

From October 1st thru December 31st Memberships will be Discounted. Reduced rate will be displayed on checkout page.

Individual Professional Guardian Membership $ 125.00 individuals who serve as court appointed professional guardians registered with the Statewide Public Guardianship Office
Individual Family/Volunteer Guardian Membership $ 75.00 family members or friends who serve as a guardian for an individual
Affiliated Individual Membership $ 125.00 individuals other than guardians who participate in activities that enhance the role of a guardian, including individual case managers, nurses, physicians, attorneys, social workers and others.

II. Member Information:

SPGO Number

Pending or Other

Prefix	First	Middle	Last	Credential

Name

Business Name

Address

Address 2

City

State

Zip Code

County

Phone

Fax

State House District Number

State Senate District Number

Click here to find your Senate and House District numbers.

E-Mail

Username

Password

Confirm Password

Hide Address

NOTICE TO GUARDIANS:

It is the Policy of the Florida State Guardianship Association that all Guardian members will, as a condition of membership, affirm they have read and will comply with the NGA Ethical Principles, adopted by the Florida State Guardianship Association as a guideline for appropriate practice. Please indicate your affirmation by signing here Ethical Principles may be viewed here.

I Agree
Signature

III. CHAPTER MEMBERSHIP (choose as many as desired):

FSGA encourages members to join a local chapter for incrased networking opportunitites and effective involvement. FSGA state organization membership is required in order to join a Chapter. This membership fee is in additional to the FSGA membership fee and will be sent to the local Chapter.

IV. Other Benefits

B. Please indicate if you would like to list your website link in the FSGA online member directory. Available for a fee of $25.00

Display Website
Website URL
Website Display Text

C. Please indicate if you would like to make an additional contribution (optional). Donors will be recognized for their support on the FSGA website:

Bronze ($10-$100)
Silver($101-$250)
Gold ($251-$500)
Platinum ($501 & up)

Donation Amount

V. PAYMENT:

Pay with your Credit Card accepts all major credit cards
Offline Payment pay by sending a check