Macopin PTA

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PTA Membership Registration Form

2008-2009

Please complete the information below.  Send this form, along with your payment of $6.00 per card to the school office marked “PTA – Membership".  Checks can be made payable to Macopin PTA. Each person registering will receive his/her own PTA membership card (sorry there are no family memberships).

PLEASE PRINT CLEARLY

Parent/Guardian Name: _________________________________________Cost:  $6.00

E-Mail Address: _________________________________________________________

Parent/Guardian Name: _________________________________________Cost:  $6.00

E-Mail Address: ­­­­­­­­­­­­­­­­­­_________________________________________________________

Other (Grandparent, babysitter, etc.): _______________________________Cost:  $6.00

E-Mail Address: _________________________________________________________

Amount Enclosed: _________________

Telephone #: __________________________________Cell Phone #:___________________________________

Student’s Name: ______________________________Grade: _____Teacher: _____________________HR____

Student’s Name: ______________________________Grade: _____Teacher: _____________________HR____

Student’s Name: ______________________________Grade: _____Teacher: _____________________HR____

   Thank you for your support!

                                                                                                                                Rita Firmender, 973 853-5032

                                                                             Membership Chairperson

*THE PTA DOES NOT SOLICIT VOLUNTEERS FROM THEIR MEMBERSHIP*

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For PTA use only       Payment Received:   Date__________ Cash__________