Print out and complete the application.  Send payment and application to:
Florida Entomological Society, P.O. Box 1007, Lutz, FL 33548-1007
(PH: 813-903-9234, FAX: 813-979-4908) email:

Please enroll me as a: ___ New Member     ___ Renewing Member   for the year beginning January 1, _____

First name[s]  (Given name[s])

Last Name[s]  (Family  name[s] or surname[s])

Address 1:_____________________        Phone:________FAX: ________ 

Address 2:_____________________          E-mail:_______ URL:_________


Zip/Postal Code:_______ Country:___________    Area of Interest:______ 
             Please indicate type of membership:

Student Membership (include verification)


Full Membership


Corporate Membership


Sustaining Membership


Institutional Subscription

($ 50.00)

Tax-deductible donation for:


      Student awards/travel

$ _______

      other (                        )




   Total enclosed  $_______   Check payments must be made in U.S. dollars and drawn on a U.S. bank. Visa and MasterCard (only)  accepted.

Credit Card Type___      Card #_______________ Exp. Date____