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MEMBERSHIP APPLICATION/CONFERENCE REGISTRATION FORM

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Please note that in order for you to be a member with the organization you MUST be a, Law Enforcement Officer, Corrections Officer, Prosecuting Attorney, Sexual Assault Nurse, or a profession that specializes in the care and assistance with victims of sexual related crimes.

Take a moment and fill in the form below. Once this form is completed press the “Submit” button. You will be taken to a page where you can select and pay for membership or conference registration.

Please indicate New Member or Renewal *New MemberMember Renewal

Please indicate which form you are submitting. *

Title: *

(i.e. Detective, Attorney, Nurse......etc)

Full Name: *

(first, middle, last name)

Email: *

Home #: *

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Office #: *

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Job Description

Agency Address

Agency Name *

Street Address

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City

Zip

State

Home Address

Street Address

Address continued

City

Zip

State

Comments

If paying by check, follow these instructions. Otherwise press "Submit" to be taken to Online Payment

Make checks payable to: Florida Sex Crimes Investigators’ Association,Inc.

P.O. Box 122138, Ft. Lauderdale, Florida 33312

If you are sending payment for the membership or conference via snail mail, please fill out this form then print prior to submitting. Enclose the printed copy with your check.

Please Enter Check or PO Number for Tracking.