2021 Membership Application

This membership is for individual(s) participating, implementing, creating and developing a Fats, Oils and Grease Program that is responsible for the compliance of commercial waste generators and/or transporters are eligible for membership in the Southeaster F.O.G Alliance. There is a separate type of membership for Industries and Commercial Transporters. Please fill out the information below and select a membership level you are wishing to obtain. You can pay with credit card or print down and mail in your payment. In our effort to be more environmentally conscious, Your membership information and confirmation of your membership, can only be sent via this form. Please print down a copy for your records. Note: Annual membership term runs from January 1, 2021 - December 31, 2021.

Todays Date: *

Date of Application Hour Minutes AM/PM Option

Organization: *

Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email: *

example@example.com

Phone Number: *

Area Code Phone Number

Fax Number: *

Area Code Phone Number

City/County Website: *

www.yourcompany.com

Membership Types: *

Individual Membership: $ 50.00

Associate Membership $ 50.00

Retired Membership $ 10.00

Organization Membership (1-3 Members Only) $ 100.00

Multi-Organization Membership (4-10 Members) $ 300.00

Total $ 0.00

Member Name #1:

First Name Last Name

Email Member #1:

example@example.com

Members Name #2:

First Name Last Name

Email Member #2:

example@example.com

Member Name #3:

First Name Last Name

Email Member #3:

example@example.com

Additional Members (4 to 10) Please input Name and Email Address and phone number in the below box:

Signature *

PLEASE USE YOUR MOUSE TO SIGN FORM Clear

This is an electronic form. You must fill in and print down this form from your browser if you wish to mail in your payment. Please remit payment to the address below. You can submit payment from this form electronically if you so wish. Please note that Pay/Pal is our credit card processing company. Due to card safety reasons you can only process on payment per day. If you have multiple applications and your trying to process a credit card transaction you will be unable to do so. This is for your security. Please pay only one student per day.

Remit Registration if mailed to:
Southeastern F.O.G Alliance
P.O. Box 4 Griffin, Georgia 30224
Attn: Treasurer

Make Checks Payable to: Southeastern F.O.G Alliance
Federal Tax I.D. Number: 06-1773755
Georgia NonProfit Corporation #: 10021910

Membership Questions Please contact us at sfa@southeasternfogalliance.org

The Southeastern FOG Alliance uses PayPal to process credit cards for this event. When you click "Submit Pay With Credit Card" you will be sent to the PayPal page to begin payment processing. You do not have to enter an email address or create a paypal account to process payment. You can click "pay with debit or credit card" and it will take you to the required information.