Membership 2010-2011

NAME: _______________________________________________________________

Child(ren) at BMS ______________________________ Grade(s)_________________________

Child's Homeroom Teacher ______________________________ Room # ______________

MEMBERSHIP LEVEL (Check one):

$8.00 ______ (includes paw print keychain to the first 100 members)

$10.00 _____ (includes Bellport Pride Backpack to the first 100 members)

EMAIL ADDRESS: ________________________________________________________________

PHONE: ________________________________________________________________

Available to volunteer: Yes _____ No _______ (Email or phone contact will be made on occasion to request assistance, this is not obligatory.)

Please check the topics you would be interested in learning more about at future PTA meetings

Internet Safety _____________ Bullying ________________ Parenting Skills _________

Testing Explained ___________ Gang Awareness _________ Curriculum ____________

Drug/Alcohol Awareness ______

Other Health Issues _______

Other ideas not previously mentioned. Your thoughts and comments are appreciated. _________________________________________________ _________________________________________________

THANK YOU FOR BEING PART OF THE PTA - EVERY CHILD. ONE VOICE.

Please mail form with payment to: Bellport Middle School PTA Membership, 35 Kreamer Street, Bellport, NY, 11713

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

The Bellport Middle School PTA thanks you for your support.