2018-2019 FBLA at Dacula Middle Membership Form
Future Business Leaders of America is the largest student organization in the nation and our Dacula Middle School chapter is one of the largest and MOST ACTIVE chapters in the state of Georgia! We look forward to adding you to our team and doing great things for our school, community, region, and state as we all strive to become better leaders.

The only way to pay this year will be through the MyPaymentsPlus system. If you need to pay in cash for any reason, you may pay Mrs. Jones or Ms. Lawrence but please make sure your money is in an envelope with your name on it before you turn it in. Also, please make sure you fill out the form below before making your payment so we have your information in our system.

Thank you for joining FBLA!

First Name *
Your answer
Last Name *
Your answer
Grade *
Who recruited you to FBLA or how did you hear about our chapter? (If you put a person's name down, he or she will receive points for recruiting you.) *
Your answer
1st Period Teacher's Full Name (Example: Thelma Sanford) *
Your answer
Student Cell Phone # (If applicable)
Your answer
Student E-mail Address (If applicable)
Your answer
1st Emergency Contact Name *
Your answer
1st Emergency Contact # *
Your answer
1st Emergency Contact E-mail Address *
Your answer
2nd Emergency Contact Name *
Your answer
2nd Emergency Contact # *
Your answer
2nd Emergency Contact Email Address *
Your answer
Membership Option: *
T-shirt Size if you would like to order one of our shirts for this year...
How do you intend to pay for your membership OR membership and T-shirt? *
Please make sure you submit your membership/T-shirt dues to Mrs. Jones or Ms. Lawrence OR pay online in order for your membership to be processed.
Were you a paid FBLA member last year? (This lets me know if you are already in the system. Everyone must still pay dues each year. EVEN ME!) *
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