Please Type in the Form Fields Provided

Please Type in the Form Fields Provided

SUSTAINING INDUSTRY PARTNER

2012 – 2013MEMBERSHIP FORM

FSNA SIP Membership is valid August 1, 2012 – July 31, 2013 and is a company membership with one company employee serving as the primary company representative. The primary representative will receive all FSNA related communications (including one copy of the quarterly magazine School Food) and is responsible for disseminating it to others within the company. If there is a change in the company representative or contact information, notificationmust be provided in writing to the FSNA office.

Please type in the form fields provided.

Company Name:

(How it will appear in all FSNA communications, including our quarterly publication.)

Address:

City: State: Zip:

Website:

Primary Company Representative:

Email Address:

Office Phone: Cell:

Secondary Company Representative:

Email Address:

Office Phone: Cell:

Please select the amount(s) to be included in your payment:

Annual Membership Dues*:$250

Future Leadership Scholarship Fund*: $250 $500 $750 $1,700

Payment Options: Visa MasterCard American Express Check Enclosed

Card Holder’s Name:

Signature of Card Holder: ______

Credit Card Number:

Expiration Date: /

CVV: (the 3 digit code on the back of Visa/MC, or 4-digit code on AMEX above account number)

Send completed forms and payment via:

Email to: Lorie Grooms at or

Mail to: FSNA, Attn: SIP Membership; 124 Salem Court, Tallahassee, FL 32301

*FSNA SIP dues are not deductible as a charitable contribution for federal tax purposes. $50 of your membership and all of Future Leadership Scholarship Fund donations will go to the Florida School Food Service Foundation – this portion is tax-deductible as a charitable contribution.

FLORIDA SCHOOL NUTRITION ASSOCIATION (FSNA)

SUSTAINING INDUSTRY PARTNER (SIP)

MEMBERSHIP DETAILS

The FSNA SIP membership benefits are available during the membership period:

August 1, 2012 – July 31, 2013

By becoming a SIP Member, your company is supportingboth the Florida School Nutrition Association and the Florida School Food Service Foundation. Each member company will receive the following benefits:

Access to Information

  • Complete and up-to-date listing of all Florida School District Food Service Directors and Supervisors.
  • County Purchasing Profiles – detailed analysis regarding district bid process, provided via disc at the Annual Conference.
  • One subscription to the School Food in Florida publication.
  • Annual Conference Prospectus provided one month early, which allows you to have first choice of exhibit booth locations.
  • FSNA communications regarding the association and industry.

Name Recognition

  • In each quarterly issue ofSchool Food in Florida.
  • In the Annual Conference Program (April 4 – 6, 2013 in Orlando, FL).
  • On the FSNA website ( with a link to your website, if provided on the membership form.

Discount

  • Pay your membership by December 1, 2012 and receive $100 off one booth at the Annual Conference.(Brokers cannot offer $100 off each one of their manufacturers’ booths. Each company must be a SIP to take advantage of this opportunity.)

Be Heard

  • Vote for the SIP Representative to serve on the FSNA Executive Board. This person is your voice for what the industry needs and wants in Florida.
  • Have the opportunity to run for SIP Representative.
  • Have the opportunity to be nominated for the SIP Advisory Board.
  • Complete surveys regarding the association and industry.

Future Leaders Scholarship Fund

  • For the first time, SIP Members will have the opportunity to provide scholarships to our future leaders so they can attend the National Leadership Conference (NLC). NLC plays a critical role in training state leaders, building strong networks, and assisting state organizations with membership growth. The program is designed specifically for incoming state leaders (President-elects, Vice Presidents, Membership Chairs, and local association leaders).
  • The 2013 NLC will be in Savannah, GA at the Marriott Riverfront hotel on April 18-20.
  • Scholarship Opportunities: 1. Future Leaders SIP Scholarship General Fund: Bronze $250;

Silver $500; Gold: $750 2. Future Leaders [insert company name] Scholarship: $1,700