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NMHS FBLA-Membership Form
Please answer each question and submit this form, along with your $25 membership dues.
Pay online by visiting:
https://newmanchesterhs.revtrak.net/clubs-and-activities/#/list
Email Dr. T @
latoya.thomas@dcssga.org
for more information
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Date
MM
/
DD
/
YYYY
Last Name
Your answer
First Name
Your answer
Personal Email Address (not your school email)-THIS IS IMPORTANT WITHOUT IT I CANNOT REGISTER YOU. MAKE SURE YOU CAN ACCESS THIS EMAIL.
Your answer
Have you Paid your $25 Dues?
Yes
No
Will Pay soon
Clear selection
Grade
8th Grade-Incoming Freshman
9th
10th
11th
12th
Clear selection
Birth date
MM
/
DD
/
YYYY
Parent(s) Name, best contact number
Your answer
Were you recruited by a student? Enter the Full Name of student who referred you?
Your answer
Do you have siblings at the school? List their name(s) and grade(s).
Your answer
Race or Ethnicity
Black or African American
White
Hispanic, non-white
Asian
American Indian or Alaskan Native
Other:
Clear selection
Gender Identity
Female
Male
Other
Clear selection
T-Shirt Size (unisex)
Small
Medium
Large
XL
2XL
3XL
Clear selection
First Period Teacher (If not sure type unknown)
Your answer
Have you ever been a member of FBLA? This includes middle school chapter.
Yes
No
Clear selection
Are you currently enrolled in a Business or Computer Science Course? If yes, list the course and the teacher (CTAE A Building).
Your answer
Would your parent(s) and or Guardian be willing to work with FBLA during the school year? (Chaperone, speaker, etc.)
Yes
No
Maybe
Clear selection
Are you a member of any other organization? Club or sport? Please list all.
Your answer
Are you interested in being an Officer next year?
Yes
No
Maybe
Clear selection
Parent/Guardian Name, email and phone number
Your answer
Home address
Your answer
Do you drive to school?
Yes
No
Clear selection
Do you have any dietary restrictions? Please be specific.
Your answer
Allergies? Please be specific.
Your answer
What would you like to get out of your FBLA experience this year? Be specific.
Your answer
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