* = Required Fields
Name:
*
Company:
Address:
*
City:
*
State:
*
Zip:
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Phone:
Fax:
Email:
*



Contact Person for URL Link:
Link Address:
Phone:
Fax:



Online Signature:
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Date of Application:




Submit the above information and send a $250.00 check for your annual Sponsorship Fee to:
John Rencher, FLAGFA TREASURER, City of Fort Lauderdale
1350 West Broward Blvd., Fort Lauderdale, FL 33312
Telephone: 954-828-5765    Fax: 954-828-5783    e-mail: jrencher@fortlauderdale.gov

PLEASE MAKE ALL CHECKS PAYABLE TO: FLAGFA



I understand that by forwarding this request and obtaining approval to post a URL link or otherwise access to my company’s website by FLAGFA that I voluntarily do so and support this organization. I am providing a link and access to an official site for fleet related business purposes only. I hereby hold FLAGFA as an organization and association, FLAGFA officers, FLAGFA Regional Representatives- individually and as officials, Exploritech, Inc., its employees, agents, subcontractors as well as system administrators harmless for any legal issues involving this participation.

If for any reason incorrect or inaccurate information is provided to FLAGFA for this link, it is my responsibility to immediately contact FLAGFA for request and make any corrections as well as paying for any costs associated with damages that may have occurred due to this error.
USERNAME


PASSWORD


NAME

EMAIL