Membership 2010-2011

NAME: ________________________________________________________

Student at BHS _________________________________________

Grade(s)_________________________

Students Homeroom Teacher ______________________________

Room # ______________

MEMBERSHIP LEVEL (Check one):

$10.00 ______ (Parent or Staff Member)

$6.00 _____ (Student Member)

Additional Student Memberships are $6.00.

EMAIL ADDRESS:

_________________________________________________________

PHONE:

_________________________________________________________

TOTAL ENCLOSED $______________

Please consider rounding off your $16.00 to $20.00. Of each membership received, part of it goes to NYS PTA Association for membership dues.

Available to volunteer: Yes _____ No _______

Email or phone contact will be made on occasion to request assistance, this is not obligatory and is not part of membership.

Your thoughts and comments are appreciated.

_________________________________________________

_________________________________________________

THANK YOU FOR BEING PART OF THE PTSA.

Please mail form with payment to: Bellport High School PTSA c/o Membership, 205 Beaver Dam Road, Brookhaven, NY, 11719

We will place your membership card in your students homeroom teachers mailbox and will let you know by email when this is done. Please check with your child regarding receipt of your membership card.

The Bellport High School PTSA thanks you for your support.