2018 Registration Form

 

Name:                                                            

Email:                                                            

Address:                                                                                                                                 

Phone:                                                             School:                                                           

Department Chair Name and Email:                                                                                     

Status  (circle)            Full-Time       Part-Time       Student            Independent            Retired

 

 

                                                                                                                                                           

2018 Registration Receipt

Membership   (must be a member to present)                       15.00

Registration Full-Time                                                           85.00

Registration PT, ST, IS, RT                                                   60.00

Luncheon                                                                                25.00

Total                                                                                                  

 

 

Submit registration form and payment to:

 

Steve Brahlek, FCEA Treasurer

#33 Palm Beach State College

4200 Congress Ave

Lake Worth, FL 33461