UGHS FBLA Application

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Please make sure you fill in each field! Due are $20 this year. There will be an option to purchase a t-shirt at a later date!

For the email below: A personal email that you (the student) can best be reached at! It can't be your school based email as the national office will send you an email regarding membership. You won't receive it with your school one.

Email *

First Name *

Last Name *

Street Address *

City *

Zip Code *

Cell Phone Number *

Home Phone Number *

Student School E-mail Address *

Current Grade *

Student Identification Number *

1st Period Course Name *

1st Period Teacher Name *

1st Period Room Number *

2nd Period Course Name *

2nd Period Teacher Name *

2nd Period Room Number *

3rd Period Course Name *

3rd Period Teacher name *

3rd Period Room Number *

4th Period Course Name *

4th Period Teacher Name *

4th Period Room Number *

5th Period Course Name *

5th Period Teacher Name *

5th Period Room Number *

6th Period Course Name *

6th Period Teacher Name *

6th Period Room Number *

7th Period Course Name *

7th Period Teacher Name *

7th Period Room Number *

Ethnicity *

(We have to know this information for the National Website for FBLA)

African-American

Asian

American Indian

Caucasian

Hispanic

Other

How many years have you been an FBLA member?

This will be my first year

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What suggestions do you have to get more active FBLA members?

What other clubs/activities/sports are you involved in here at UGHS (or will be?) *

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