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Membership Sample Page

ROCKY MOUNT ELEMENTARY SCHOOL PTA

4-part form – press firmly- use blue or black ink

 

Student Grade Teacher
 

 

   
 

 

   
 

 

   
 

 

   

 

 

Parent/Guardian Name:                                                                                    

Address:                                                                                                             

Phone: ____________________               Email:                                                

 

PTA Package – “one stop shopping” – includes

·         2 PTA memberships – $12 (100% membership = awards and recognition

from State and National PTA);

·         tax-deductible family donation – $23 (because we don’t ask you to sell stuff!);

·         PTA calendar – $5;

·         classroom donation – $20/student (includes classroom celebration(s) and

teacher gifts for the year.  No separate requests for money from room

parent;

***Purchase the PTA Package before the first day of school and

receive a complimentary Rocky Mount Elementary car magnet***

(Select)

 

$60/1 student

 

$80/2 students

 

$100/3 students

 

$120/4 students

 

Agenda – REQUIRED FOR 2ND – 5TH GRADE STUDENTS 

                                                                                         _____ x $3.00

 
(optional) Additional tax-deductible family donation $
(optional) PTA memberships                                                  ______ x $6.00  
(optional)  Additional Teacher Gift Contribution

(for classrooms with multiple teachers)                 _____ x $15.00

 
(optional)  Pre-Order Rocky Mount Yearbook              _____ x $30.00

                   Price may increase mid-year

 
TOTAL DUE $

 

Please make checks payable to Rocky Mount PTA.  Please keep this receipt for your records

There is a returned check fee of $20.

                                                  PTA USE ONLY
Date _____      Rec’d $ ______     Cash/Check/Credit Card #________        PTA Officer___________

(CIRCLE ONE, WRITE CHECK #)                                               (INITIALS ONLY)

 

White:  Membership                                Canary: Yearbook                    Pink: treasurer                         Gold: Parent Copy