FLEECE BLANKET FORM

NAME:

_______________________________________________________________

STUDENT NAME

____________________________________________________ GRADE________

HOMEROOM # ________________________ TEACHER ______________________

ORDER:

$17.00______ One Blanket

$30.00______ Two Blankets (Better Deal, one for home, one for the car!)

Check ________ Cash ________

EMAIL ADDRESS:

________________________________________________________________

PHONE:

________________________________________________________________

If you would like to mail the form with payment, please send to: Bellport Middle School PTA Fundraiser, 35 Kreamer Street, Bellport, NY, 11713.

We will notify you by email or phone when your blanket will be available for pickup at the school.

THANK YOU FOR SUPPORTING THE PTA.