PTSA - Membership Form 2014-2015
MEMBERSHIP FORM
NAME: _________________________________________________________________________________
EMAIL ADDRESS: ________________________________________________________________________
Student ____________________________ Grade_____ Student _________________________ Grade_____
Email Address: _________________________________ ____________________________________
As a member of the PTSA, your student will also get PTSA emails. We will only send pertinent PTSA information. If you choose not to have your student get emails, please do not include thier email address.
MEMBERSHIP LEVEL (Check one):
$20.00______ (Family Membership - Maximum of 4)
$10.00_____ (Single Membership)
TOTAL ENCLOSED $______________
Comments, Suggestions, Ideas:.
______________________________________________________________________
______________________________________________________________________
Please mail to: PTSA Membership c/o Bellport High School
205 Beaver Dam Road
Brookhaven, NY 11719-9707
THANK YOU FOR YOUR SUPPORT AND FOR BEING PART OF THE PTSA.
Check / Cash
Check #________ Amount $ _________ Member # ______________________________
NAME: _________________________________________________________________________________
EMAIL ADDRESS: ________________________________________________________________________
Student ____________________________ Grade_____ Student _________________________ Grade_____
Email Address: _________________________________ ____________________________________
As a member of the PTSA, your student will also get PTSA emails. We will only send pertinent PTSA information. If you choose not to have your student get emails, please do not include thier email address.
MEMBERSHIP LEVEL (Check one):
$20.00______ (Family Membership - Maximum of 4)
$10.00_____ (Single Membership)
TOTAL ENCLOSED $______________
Comments, Suggestions, Ideas:.
______________________________________________________________________
______________________________________________________________________
Please mail to: PTSA Membership c/o Bellport High School
205 Beaver Dam Road
Brookhaven, NY 11719-9707
THANK YOU FOR YOUR SUPPORT AND FOR BEING PART OF THE PTSA.
Check / Cash
Check #________ Amount $ _________ Member # ______________________________
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