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Application Form

 

Eligibility Requirements: Membership in the Counselors’ Network is open to any Universally Accredited member, in good standing, of the Florida Public Relations Association who is actively engaged in providing counseling service, either as a full-time principal, officer, partner or employee of a public relations firm, corporation, organization, or agency, and who has been in a counseling capacity for at least three years and has ten years public relations experience.

* Denotes A Required Field
First Name: *
Last Name: *
Title:
Organization:
Mailing Address:
 
City:
State:
Zip Code:
Phone: *
  (NOTE: Area code must be entered)
Fax:
Email: *
If accredited, please check: CPRC APR Other
Last three years spent in counseling capacity: Yes No
Ten years of public relations experience Yes No
FPRA Member: Yes No
Sex: Male Female

Payment:
Dues: $35 annually Application Fee: $20 (New CN members only)
Credit Card Type:
Exact name embossed on Card:
Credit Card Number:
  (NOTE: If credit card number is left blank, a representative will call you at the phone number provided)
Exp. Date: (mm/yy) /
Address where statement is received:
 
City:
State:
Zip Code:
Security Code:
(Visa/MC/DISC: last 3 digits on back. Amex: 4 digits on front.)

I hereby apply for membership in the Counselors’ Network of the Florida Public Relations Association and agree to abide by the Code of Ethics of the Association.
By checking this box I agree to the above statement

 

  
 
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