2019 FLC Registration Form

Chapter Number * 12789

School Name * Eastside high School

Primary Adviser Name * Victoria Brooks

Adviser Email Address (confirmation will be sent here) * brooks.victoria@newton.k12.ga.us

Select the Opening Session Your Chapter Will Attend * Session A: 7:00 pm - 8:15 pm

Name of Adviser #1 Victoria Brooks

T-shirt Size for Adviser #1 Medium

Registration Fee for Adviser #1 $55.00

Name of Adviser #2 Jarvis Brice

T-shirt Size for Adviser #2 3XL (add $5)

Registration Fee for Adviser #2 $60.00

Name of Member #1 Nevaeh Thomas

T-shirt Size for Member #1 Small

Leadership Track First Choice for Member #1 (Required) Advanced Leadership

Leadership Track Second Choice for Member #1 Success at Competitive Events (limit 2)
(Required)

Registration Fee for Member #1 $55.00

Name of Member #2 Chadni Patel

T-shirt Size for Member #2 Large

Leadership Track First Choice for Member #2 (Required) Advanced Leadership

Leadership Track Second Choice for Member #2 Communication

(Required)

Registration Fee for Member #2 $55.00

Name of Member #3 Johanna Pestle

T-shirt Size for Member #3 Medium

Leadership Track First Choice for Member #3 (Required) Advanced Leadership

Leadership Track Second Choice for Member #3 Communication

(Required)

Select the following options for Member #3 (extra fees Register for Statesmen Award Test
may apply)

Registration Fee for Member #3 $55.00

Name of Member #4 Jordan Spigner

T-shirt Size for Member #4 Medium

Leadership Track Second Choice for Member #4 FBLA Officership

(Required)

Leadership Track Second Choice for Member #4 Sectors of Success

(Required)

Registration Fee for Member #4 $55.00

Name of Member #5 Rebekah Mull

T-shirt Size for Member #5 Small

Leadership Track First Choice for Member #5 (Required) FBLA Officership

Leadership Track Second Choice for Member #5 Sectors of Success

(Required)

Registration Fee for Member #5 $55.00

Name of Member #6 Lily Oftedal

T-shirt Size for Member #6 Small

Leadership Track First Choice for Member #6 (Required) FBLA Officership

Leadership Track Second Choice for Member #6 Sectors of Success

(Required)

Registration Fee for Member #6 $55.00

Name of Member #7 Aryana Mays

T-shirt Size for Member #7 Small

Leadership Track First Choice for Member #7 (Required) Communication

Leadership Track Second Choice for Member #7 Sectors of Success
(Required)

Registration Fee for Member #7 $55.00

Name of Member #8 Janiya George

T-shirt Size for Member #8 Medium

Leadership Track First Choice for Member #8 (Required) Communication

Leadership Track Second Choice for Member #8 Sectors of Success

(Required)

Registration Fee for Member #8 $55.00

A. Number of Advisers Registered * 2

B. Number of Members Registered * 8

C. Number of Chaperones Registered 0

D. Total Number of Individuals Registered (A+B+C) * 10

E. Number of 2XL, 3XL, and 4XL t-shirts ordered 1

F. Number of Chick-fil-A Breakfasts ordered ($6 each) 0

I. Total Registration (Line D x $55) * $550.00

J. T-shirt Surcharge (Line E x $5) $5.00

L. Total Amount Due (Line I + Line J + Line K + Line L + $555.00

Line M) *