FGDNK-12 Membership Form
The 2019 FGDNK-12 membership subscription registration is effective January 1st and ends December 31st .
General Contact Information
Please provide name of person completing registration form (e.g., secretary, finance personnel, etc.), if different from renewing or first time member's name. This information is needed for the purpose of membership subscription follow-up.
Contact Person's Name *
Please provide name of contact person completing this form (e.g., secretary, finance personnel, etc.). If not applicable, please indicate, "N/A."
Your answer
Contact Person's Email Address *
Please provide email address of contact person completing this registration form. If not applicable, please indicate, "N/A."
Your answer
Contact Person's Title *
Please provide title of contact person completing this registration form. If not applicable, please indicate, "N/A."
Your answer
Contact Person's Phone Number *
Please provide the Phone number of contact person completing this form. If not applicable, please indicate, "N/A."
Your answer
FGDNK-12 Member Information
Please provide first time or renewing member's information below. Thank you.
Name *
Your answer
Title *
Your answer
E-mail Address *
Please provide a Florida K-12 Public School System's e-mail address.
Your answer
Phone Number *
Your answer
Name of the Florida K-12 Public School System where the individual is currently, previously, or has an impending grant interest. *
Note: Membership in the Network per by laws section 2(d) shall be limited to individuals having a direct interest, currently, previously, or impending, in grants development and implementation activities from within K-12 public school systems in the state of Florida. Therefore, please provide the name of the K-12 public school system where the individual requesting membership is currently employed, previously employed, or has employment impending.
Your answer
To maintain an accurate membership roster select the appropriate option *
If the renewal option was selected in the previous response provide the following information: Initial date of membership (if available), any/all Board of Officer position(s) held with date(s) of service *
Your answer
Provide specific grant development training requests or other suggestions to help the Board better meet member needs. *
Your answer
I am interested in volunteering to serve on the Baord of Directors *
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