From: Georgia FBLA <no-reply@wufoo.

com>
Sent: Wednesday, October 19, 2016 9:34 PM
To: Jonathan Paden (Tucker High)
Subject: 2016 FLC Registration Form

Your FLC Registration has been received. If you have more than 8 members
attending, please complete an additional registration forms as needed. If you
need to make changes to your registration, please use the substitution/change
form or the registration cancellation request form (links in the LiveBinder).
There will not be a charge for changes made through October 14. After October
14, these changes will incur a $10 per change fee.
Once you have finalized your registration without making additional changes,
you can request an official invoice for this conference by sending an email
conference@georgiafbla.org. Please allow up to 72 hours for this invoice to be
emailed to you.
Mail complete payment to Georgia FBLA, 3316-A South Cobb Drive, Suite #229,
Smyrna, GA 30080. Payment must be RECEIVED no later than October 24 to
avoid late payment penalties.
To pay for FLC Registration Fees by credit card, go to
https://georgiafbla.wufoo.com/forms/online-credit-card-payment-form/. Do
not forget to add the 3.5% processing fee to the amount due if you choose to
pay by credit card.
Membership dues for members registered which have not been received by the
registration date must be received in the national office no later than October
31 for this member to be eligible to participate in the Fall Leadership
Conference.

2016 FLC Registration Form

Chapter Number *

4041

School Name *

Tucker High

Primary Adviser Name *

Jonathan Paden

Adviser Email Address (confirmation will be sent here) *

Jonathan_L_Paden@dekalbschoolsga.org

Select the Opening Session Your Chapter Will Attend *

Session A: 7:00 pm - 8:15 pm

Name of Adviser #1

Jonathan Paden

T-shirt Size for Adviser #1

Medium

Select the following options (extra fees may apply)

Chick-fil-A Breakfast (add $5)

Registration Fee for Adviser #1

$55.00

Membership ID Number for Member #1

1978169

Name of Member #1

Nicholas Van Lue

T-shirt Size for Member #1

Medium

Leadership Track First Choice for Member #1 (Required)

Personal Financial Leadership

Leadership Track Second Choice for Member #1 (Required)

Career Success

Select the following options for Member #1 (extra fees may apply)

Chick-fil-A Breakfast (add $5)

Registration Fee for Member #1

$55.00

Membership ID Number for Member #2

2331451

Name of Member #2

Marika Daniels

T-shirt Size for Member #2

X-Large

Leadership Track First Choice for Member #2 (Required)

Communication

Leadership Track Second Choice for Member #2 (Required)

Entrepreneurship (limit 2)

Select the following options for Member #2 (extra fees may apply)

Chick-fil-A Breakfast (add $5)

Registration Fee for Member #2

$55.00

Membership ID Number for Member #3

2492330

Name of Member #3

Dip Shankar Paul

T-shirt Size for Member #3

Medium

Leadership Track First Choice for Member #3 (Required)

Business Management (limit 2)

Leadership Track Second Choice for Member #3 (Required

Career Success

Select the following options for Member #3 (extra fees may apply)

Chick-fil-A Breakfast (add $5)

Registration Fee for Member #3

$55.00

Membership ID Number for Member #4

2492333

Name of Member #4

Dip Jothi Paul

T-shirt Size for Member #4

Medium

Leadership Track First Choice for Member #4 (Required)

Business Management (limit 2)

Leadership Track Second Choice for Member #4 (Required)

Career Success

Select the following options for Member #4 (extra fees may apply)

Chick-fil-A Breakfast (add $5)

Registration Fee for Member #4

$55.00

Membership ID Number for Member #5

2500344

Name of Member #5

Tania Vasquez

T-shirt Size for Member #5

Medium

Leadership Track First Choice for Member #5 (Required)

Communication

Leadership Track Second Choice for Member #5 (Required)

Entrepreneurship (limit 2)

Select the following options for Member #5 (extra fees may apply)

Chick-fil-A Breakfast (add $5)

Registration Fee for Member #5

$55.00

A. Number of Advisers Registered *

B. Number of Members Registered *

C. Number of Chaperones Registered

D. Total Number of Individuals Registered (A+B+C) *

E. Number of 2XL, 3XL, and 4XL t-shirts ordered

F. Number of Chick-fil-A Breakfasts ordered

G. Number of Monopoly Teams (1-3 members).

H. Total Registration (Line D x $50) *

$300.00

I. T-shirt Surcharge (Line E x $5)

$0.00

J. Chick-fil-A Breakfast Fees (Line F x $5)

$30.00

K. Monopoly Tournament Fees (Line G x $12)

$24.00

L. Total Amount Due (Line H + Line I + Line J + Line K) *

$354.00