FORM A
To compete, registration forms and fees are due by March 17, 2017.
Please print and keep a copy of all forms and checks for your files.
Make check payable to Texas PBL and mail to State Bookkeeper.
Send a copy of Forms A-B & C to the State Chair via e-mail.
Therese H. Palacios, Chair State Bookkeeper Thad Reid, CPA
Texas Phi Beta Lambda of Lewis, Kaufman & Co.
P. O. Box 831085 2308 W 5th Street
San Antonio, Texas 78283 Plainview, Texas 79072
Questions: (P) 210-380-4429 • (F) 210-225-0044
E-mail:CHAPTER INFORMATION
College / Adviser
CONFERENCE FORMS (check these forms off as you complete them)
Registration Checklist/Summary (FORM A)
State Leadership Conference Attendees and Competitive Events Form (FORM B)
Excel—TX PBL Online Testing (FORM C) – taken from February 13 - March 24, 2017
Chapter Business Person of the Year (Enclose recommendation following the Event Guidelines)
Who’s Who in Texas Phi Beta Lambda (Adviser: Enclose letter of recommendation)
REGISTRATION SUMMARY
Total Members Attending (chapter or virtual) by March 17 / X / $50* / =
Total Advisers Attending / X / $0 / =
Total Professional Members Attending / X / $20* / =
Total Guests Attending / X / $20* / =
Total Attending for Online Testing Only and Not Attending the SLC in Houston – Test must be taken by March 24, 2017 / X / $40* / =
Total On-site Attending (after 3/17/17) no events allowed / X / $60 / =
* No refunds after March 24 TOTAL AMOUNT ENCLOSED
VOTING DELEGATES. Each chapter is entitled to a minimum of 2 voting delegates. Chapters with more than 50 paid members receive a third voting delegate; those with more than 100 members may register four voting delegates. Delegates vote on bylaw amendments and for state officer election.
Delegate #1
Delegate #2
Delegate #3 (50+ members)
Delegate #4 (100+ members)
TEXAS PHI BETA LAMBDA / State Leadership Conference Attendees and Competitive Events Form
FORM B
Chapter
Street Address / City / Zip
E-mail Address (preferred!) / Cell Phone
College Phone / Fax Number
Name of College Key Administrator (Dean, Dept. Head, etc.) / Administrator E-mail Addresses
Names of Advisers / Adviser E-mail Address / Attending TX SLC?
Please print and alphabetize the names of Chapter Attendees (indicate position if an officer). / Attending SLC *
Yes/No / Please print. List Competitive Events (Only 2 per student).
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* Please note that a No answer means that the student is competing but not going to Houston. Performance events do Not have this option. For page 2, please make a copy of this form and continue your registration.
* The following refund policy will be in effect for the 2017 State Leadership Conference:
All PBL State Leadership Conference cancellations and requests for refunds must be made in writing and e-mailed to . To receive a full refund, requests must be received within the time frame of March 1-March 24, 2017. Requests for refunds within two weeks of the start of the conference will not be eligible for a refund. However, the chapter may substitute another paid member who can participate in the conference, but cannot compete. No-shows are nonrefundable. Please allow two weeks after the conference for processing your refund.