Virginia Fbla-Pbl, Inc

FOUNDATION MEMBERSHIP FORM

VIRGINIA FBLA-PBL, INC.

Please submit this completed form with your membership contribution. Duplicate a copy of the form for your records. This is a tax-deductible contribution.

Date

Name of School, Region,

Individual, or Business to

Receive Membership Credit:

Your Name (if different from above):

Mailing Address:

Telephone Number: ()

FBLA Region (if applicable):

Local or Regional Adviser:

Amount of Contribution:

Please check the type of membership for which you are submitting:

Member $1 to $99 annual investment

Bronze $100 to $249 annual investment

Silver $250 to $499 annual investment

Gold $500 to $999 annual investment

Life $1,000 or more one-time or cumulative investments

Business Life $10,000 or more one-time investments or cumulative investments

(Dues-paying Professional Division members are automatic members of the Foundation.)

Please make checks payable to Virginia FBLA-PBL Foundation, Inc., and mail with this completed form to by March 1 to:

Virginia FBLA-PBL Foundation, Inc.

115 Marshall Lane

Winchester, VA 22602