MEMBERSHIP APPLICATION
           THE FUNERAL SOCIETY OF MID-FLORIDA, INC. 
           PO BOX 740413, Orange City, FL 32774-0413
           Phone (386)-804-5640  FSMFLA@gmail.com

Purpose: To promote pre-planning of end-of-life decisions that ensure compliance with the member's wishes.
    While we do not address legal issues, we stand ready to assist our members with other issues such as
    funeral homes*, membership cards, personal information form(s), and obituary suggestions.

*  Our only cooperating funeral home at this time is Lankford Funeral Home in DeLand, Florida.

    I (We) would like to join the Funeral Society of Mid-Florida, Inc..
       a check for $15.00 for each adult lifetime membership is enclosed.

        _______________________________________________________
        NAME 

       _______________________________________________________
        NAME (SPOUSE / PARTNER IF APPLICABLE)

    _______________________________________________________
       STREET ADDRESS

     _______________________________________________________
       CITY, STATE, & ZIP CODE
   
​__________________      __________________________________
        PHONE NUMBER              EMAIL ADDRESS (IF APPLICABLE)
   
​_______________________________________________________
      SIGNATURE                                                              DATE 
   
​_______________________________________________________
      SIGNATURE ( SPOUSE / PARTNER)                        DATE

     OPTIONAL SURVEY- HOW DID YOU HEAR ABOUT THE FUNERAL SOCIETY OF MID-FLORIDA, INC.?

         (  ) FRIEND                   (   ) NEWSPAPER                 (   ) TELEVISION

        (  ) WEB SEARCH       (   ) OTHER _________________________

       THANK YOU! 

aaaaa