FLEECE BLANKET FORM

STUDENT NAME:

________________________________________________________________________________________________________________________

GRADE_______________________________________________________

HOMEROOM # _________________________________________________

TEACHER ____________________________________________________

ORDER:

$15.00 FOR EACH BLANKET

NUMBER OF BLANKETS BEING ORDERED: ______

CHECK ______________ CASH ______________

Total Amount Enclosed $____________

PARENT/GUARDIAN NAME:

___________________________________________________________

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.