PTA MEMBERSHIP FORM

Thank you for your interest in joining the PTA! Please fill out the form below and return t 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: ______________________