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Firm Membership Application

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AIA Florida Firm Profile Verification

This information will be published in the AIA Florida Firm Directory. Please carefully review the following information and make any changes/updates on this form.

Membership of Firm Principal must be in good standing for the firm to be listed in the directory.

Firm Information
Firm Name:
Principal First Name:
Principal Middle Name:
Principal Last Name:
Principal Suffix:
Principal Designation:
License Number:
Year Established:
Address:
City:
State:
Zip Code:
Phone:
E-Mail:
Web Site:
Other Principals:
Please list the number of different types of staff you have: Total # of Employees Licensed Architects Architect Degree Graduates/Interns Professional Engineers Interior Designers Admin/Secretarial/Other Cities with Other Florida Branches: Recently Completed Projects (include up to 10): Awards and Accolades (within past 5 years):
Intern-Friendly Recognition Program
Is your firm dedicated to fostering leadership and involvement amongst young professionals? If so, AIA Florida wants to recognize you... and it's free! Check all that apply below: My firm pays full or partial dues for associate members / interns. My firm provides a tangible benefit to associate members / interns for passing any ARE division, or passing the full ARE Exam. Explain: My firm provides multiple mentoring opportunities for associate members / interns inside or outside the office. My firm provides opportunities for associate members / interns to complete IDP hours with one-the-job experience.
Present Type of Work Your Firm Handles
Commercial Office Facilities % of work, if significant Education Facilities % of work, if significant Food Entertainment Facilities % of work, if significant Graphic/Industrial Design % of work, if significant Hotel/Convention Facilities % of work, if significant Industrial Facilities % of work, if significant Institutional Facilities % of work, if significant Interiors % of work, if significant Landscaping Site Design % of work, if significant Medical Facilities % of work, if significant Multiple Family Dwellings % of work, if significant Planning Urban Design % of work, if significant Public Work % of work, if significant Recreational Facilities % of work, if significant Religious Facilities % of work, if significant Renovations/Restoration % of work, if significant Residential % of work, if significant Retail Facilities % of work, if significant Other % of work, if significant
Dues
Your dues are computed at a rate of $125 per licensed architect in your firm:
	TOTAL: $0.00
Thank You for Your Support!
	$25 of your Firm Dues directly benefits the Florda Architects' Political Action Committee. This portion is recommended but not required. Contributions are not deductible for Federal tax purposes.
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Credit Card Expiration	010203040506070809101112 / 20192020202120222023202420252026202720282029
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	On Visa & Mastercard, the 3 digit code on back of the card. For American Express, the 4 digit code on the front of the card printed above and to the right of the raised credit card number.
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