Registration Form for Category A & B Licensees

Please complete the following registration form if you are interested in affiliating with the FLA as a Category A or B licensee. By registering with the FLA you are indicating that you wish to proceed with your affiliation in a timely manner. We will communicate to our affiliated colleges and universities that your company’s application is pending and that you will be initiating the application process. Once we receive your completed registration form, you will receive an e-mail that details the application process and requirements for you to remain pending with the FLA as we work with you to determine how and when you should complete the application process.

* indicates required field

Company name: *
Contact name: *
Contact title: *
Address 1: *
Address 2:
City: *
State or Province: *
Zip / Postal code: *
Country *
Phone: *
Fax:
Email: *
Company website:

Please describe the primary focus of your business.
If your company does not have a direct relationship with the manufacturer, please describe how the product is procured. (For example, blank products are bought through a distributor/broker.)
Does your company participate in any factory compliance programs?
	Yes No
Company Total Annual Revenues*

Category *
Category A (A company with annual consolidated revenue of $50 million or more that intends to participate fully in the FLA with all the rights and privileges accorded)
Category B (A company with annual consolidated revenue of $50 million that does not participate fully in the FLA, but agrees to submit to the monitoring process facilities that produce or manufacture products under license from an FLA school)