FAHN Membership

To become a member, print and complete this page and mail to the address below with

your dues payment.

Florida Association of Hostage Negotiators

Membership Application

(Please print or type information)

Region: _______

Name: __________________________________________________________________

Rank/Title: ______________________________________________________________

Residence Address: _______________________________________________________

City: ____________________________ State: _______________ Zip: ______________

Business Phone: (___) __________________ Home Phone: (___) __________________

Date of Birth: ______________________ County: _______________________________

E-mail Address: __________________________________________________________

Name of Agency: _________________________________________________________

Agency Head/Title: _______________________________________________________

Agency Address: _________________________________________________________

City: _______________________________ State: _____________ Zip: ____________

Please indicate which address you would like FAHN correspondence mailed:

Agency: _______ Residence: ______

Signature: _________________________________________ Date: ______________

Annual Dues are $20.00 and checks are made payable to F.A.H.N.

Mail to:

Florida Association of Hostage Negotiators

P.O. Box 6535

Jacksonville, FL 32236