Family, Career and Community Leaders of America Union Grove High School ROOM 404

UGHS 2016-2017 Membership Form Family, Career and Community Leaders of America  Union Grove High School ROOM 404 120 East Lake Road  McDonough, GA 30252 (678) 583-8502 fax (678) 583-8850

___$30 (includes FCCLA t-shirt) or ___$25 includes FCCLA national, state, and local dues Add on other Student organization memberships: ____$18 FBLA ____$15 FFA ____$35 HOSA ____$25 Skills USA NTHS (National Technical Honor Society-By teacher recommendation)___$30 one time

Name______Age______Grade______

Mailing Address______City______Zip______

Cell Phone______Parents’ Name & Phone number______

Parent’s email address ______

Student’s e-mail______

Student’s cell phone number ______Years in FCCLA (circle one) 1 2 3 4 T-shirt size (circle one) S M L XL 2XL Ethnic background ______Gender ______Check the activities that interest you the most: _____ Leadership Opportunities _____ FCCLA Day at the Capitol (Feb.) _____ Fall Rally (Oct.) ______Fall Leadership Conference (Sept.) _____ Class Chairman _____ FCCLA Day w/ Falcons (Nov.) _____ FCCLA Officer _____ Cluster Meeting (Nov.) _____ STAR Events Competition _____ State Leadership Meeting (Mar.) _____ Committee Chairman _____ National Leadership Meeting (July) Projects _____ Community Service _____ “Adopt-a-Family” at Christmas _____ Fund Raising _____ FCCLA Week Activities-Feb. _____ Membership Drive _____ Linus Blanket Project _____ Newsletter _____ March of Dimes _____ Scrapbook _____ Summer Camp _____ Homecoming Float _____ Food Pantry Class Schedule: Class Teacher Room # 1st Period: ______2nd Period: ______3rd Period: ______4th Period: ______5th Period: ______6th Period ______7th Period ______------2016-2017 For Office Use Only: Payment Date ______Amount______Check #______Cash______