Click here to download this form as a Word file.

Name:
  
Date:
    
New or Renewal:
  
Membership Type:
  
Home Information
    
Address:
  
City:
  
State:
  

Zip:

  
Phone:
  
School Information
    
School Name:
  
Address:
  
City:
  
State:
  

Zip:

  
Phone:
  
Region:
   (same as the FBLA region you are located in)
E-mail:
  
 

Please make checks payable to KBEA.

Please mail the completed form and membership dues to:

Debbie Barnett
KBEA Treasurer
Paul G. Blazer High School
Blazer Blvd.
Ashland, KY 41102