PTA MEMBERSHIP FORM

Thank you for your interest in joining the PTA! Please fill out the form below and return it to the local PTA along with your dues payment.
When the PTA gets involved, children benefit. When you get involved with PTA, the child who benefits most is yours.

I am (yo soy)        ___ Parent/Guardian(pariente)   ____ Teacher
                             ___ Grandparent(abuelos)         ____ Faculty/Staff

Fee (Costo):      ____ Individual (primer individio)       $10.00
                         ____ Spouse (esposa/esposo)           $ 5.00
                         ____ Student (estudiante)                  $5.00

Pay to the order of (cheques al nombre de): Elmsford PTA

Name (Nombre): _______________________________________
Spouse (esposa/esposo): _________________________________
Student (estudiante): ____________________________________
Address (Direccion): ____________________________________
                   ____________________________________________
Telephone (Telefono): ___________________________________
E-mail: _______________________________________________

Children(ninos):           Grade/Teacher(Grado/Maestro):    
  
  
  
  

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Internal Use Only:
Amount Collected: _______________   Date: ___________ By Whom: ______________________