PA VIRTUAL FBLA MEMBERSHIP APPLICATION FORM

Future Business Leaders of America-Phi Beta Lambda, Inc. (FBLA-PBL) is the oldest and largest national organization for students preparing for careers in business. FBLA-PBL prepares students for “real world” professional experiences. Members gain the competitive edge for college and career successes. More than a quarter of a million students participate in this dynamic leadership organization.

FBLA-PBL will provide you with:

  • Travel opportunities
  • Challenging competitions
  • Scholarships and prizes
  • Leadership development
  • Community service experience
  • Friendship and fun

FBLA-PBL takes you to major cities throughout the United States such as Orlando, Denver, Nashville, Chicago, Dallas, Anaheim and Washington, D.C. You will get to know people in your state and across the nation at exciting leadership conferences and workshops.

Members have the opportunity to compete for awards and recognition on the local, state, and national levels in more than 50 different event categories including Web site Development, marketing, business plan, public speaking, job interview, cyber security, and many more!

Become a leader! Win money! Travel! Learn to lead! Develop friendships! Earn recognition! All of these adventures and more await you when you become a member of FBLA-PBL.

The membership dues is $15 per year. To become a member, please fill out the application form using the payment options listed below. You must include parent permission on the membership form by typing in the parent name to verify your membership. All forms are to be submitted to Mr. Bruce Boncal, PA FBLA Executive Director, by the "received by" initial deadline of October 31, 2011. Make all checks payable to: PA FBLA

Payment Options:

  1. Check Payment: Printout the application and enclose your check for $15 and thecompleted application and send to:
    Mr. Bruce E. Boncal
    PA FBLA Executive Director
    P.O. Box 5085 (318 High Street--if shipping overnight)
    Jersey Shore, PA 17740
  1. Credit Card Payment: Email the completed application to Mr. Bruce Boncal at and follow the directions listed below to make your payment:

PA FBLA uses the secure site of PayPal for all credit card transactions. PayPal is safe and secure to use. You do not need a PayPal account to process a credit card transaction. PA FBLA accepts Visa, MasterCard, American Express and Discover. To process a credit card transaction, there are five easy steps:

1) Log on to the PA FBLA web site at

2) Click the Credit Card Payments menu on the left side of the page;

3) Select the Student Membership Credit Card Processing Form;

4) Complete the Credit Card Processing Form. (A 3% membership

convenience fee will be added)

5) Scroll down and enter the following information where requested:

a) Member Name

b) Name of Person Submitting Payment

c) Then click Pay Now (Please know that TAX is not charged. )

AUTHORIZATION: My signature below confirms that I have authorized my credit card to be charged for the amount shown on Line F above.
Member
Name:
Parent
Name: / Date:

2011-2012

PA VIRTUAL FBLA MEMBERSHIP APPLICATION FORM

To become a member, please fill out the form below.

Title _____ First Name: ______Last Name ______

Address: ______

City: ______State: ______Zip: ______

High School Attending: ______

School District You Reside In: ______

Home Phone: ______Cell Phone: ______

Email: ______

Birthday: ______Grade Level: ______

OPTIONAL INFORMATION FOR DEMOGRAPHIC PURPOSES ONLY:

RACE ______GENDER ______

MEMBERSHIP VERIFICATION:

Please read the statement below and verify by typing your names on the appropriate lines.

I verify/give consent for the above named-student to be a member of the PA Virtual FBLA Chapter by typing your name on the lines below:

______

Member Name Parent Name