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FSC Membership Application

To apply for membership to the Free Speech Coalition, please print out this application, fill in all required information including payment option.

Membership dues are calculated based on annual sales volume. Please, indicate your level of membership dues using the sliding scale below. Business and individual flat rate membership dues also are listed below.

Please, include phone and email contact information.

Please, print out the form and send to our office via FAX or regular mail.
We also can process your membership over the phone.


Free Speech Coalition
P.O. Box 10480
Canoga Park, CA 91309
Phone (818) 348-9373
FAX: (818) 348-8893


For more information, contact FSC at (818) 348-9373 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

(* required)

*Primary Contact Name:
*Performing/Professional Name:
(if applicable)
*Corporation Name:
*Additional Company Names:
(including DBAs)

Your title:
(CEO, President, Proprietor, etc.)
Physical Address:
*Phone:
Contact Name:
Alternate Contact Name:
Alternate Phone:
*Primary Email Address:
*Website URL:
if applicable



MEMBERSHIP TYPES

Please select industry affiliation from the list below.

*Industry Sector/Niche (required, please circle one):

A Content Production Company
B Distributor/Wholesaler
C Adult Products Manufacturer (sex toys, novelty, gear, apparel)
D Internet Adult Website or Affiliate Program
E Online Content Provider (VOD, PPV, mobile, etc.)
F Online Support Services (hosting, billing, Web design, software, etc.)
G Online Adult Product Retailer
H Adult Product Mail Order Company
I Retail Chain/Brick-and-Mortar Store
J Home Party Company
K Talent Agency
L Publicity Agency
M Dance Clubs (include number of locations)
N Industry Professional (individual only)
O Consumer Advocate (individual, non-voting membership)



DUES BASED ON ANNUAL SALES VOLUME

(applies to businesses that ARE NOT law firms, talent agencies, dance clubs, retail brick-and-mortars, individual industry professionals and consumer advocates):

A $10,000,000 & Over$8,000
B $5,000,000 - $9,999,999$4,000
C $1,000,000 - $4,999,999$2,000
D $500,000 – $999,999$1,000
E $200,000 – $499.999$500
F $100,000 – $199,999$300
G $0 – $99,999$100



FLAT RATE DUES

(applies to following categories)

Talent Agencies, Law Firms — $500

Dance Clubs, Retail Stores (physical locations) — $300 per location

Industry Professional, individual — $50

Consumer Advocate (non-voting, restricted access to business resources) — $25

PLEASE ENTER TOTAL AMOUNT PAID $____________________



BILLING INFORMATION:

(applies to businesses that ARE NOT law firms, talent agencies, dance clubs, retail brick-and-mortars, individual industry professionals and consumer advocates):

X For the full Amount
X In quarterly/monthly payments ($1,000 membership and above, only)

 

Credit Card Type:

Credit Card Number:

Expiration Date:

Security Code
(front or back of card):
Billing Zip Code:
Cardholder Signature:



Membership dues and contributions to the Free Speech Coalition, a 501(c)6 non-profit organization are not tax deductible as charitable contributions, but may be deductible as ordinary and business expenses.

 

 

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