Marion Jordan PTA 2009/2010
PTA Membership/Directory Order Form
(Due August 28th)
Section 1- Privacy Policy
The directory
is published solely for the information and convenience of PTA members. This information is NOT to be used for
solicitation. You must be a member of the PTA to receive the directory.
_____I
want to be a general PTA member, and want information in the directory.
_____I
want to be a general PTA member, but do NOT want information in the directory.
_____I
do NOT want to be a PTA member, but I DO want my information listed.
_____I
do NOT want to be a PTA member, and I do NOT want my information listed.
_____Check
here if you are a new family to Marion Jordan!
Welcome!!!
Section 2 – Membership/Directory Information
Please print clearly the following
information (as it would appear in the directory if applicable):
Mother’s
Name________________________________________________________________________
Father’s
Name________________________________________________________________________
Mother’s
Address______________________________________________________________________
City___________________________
State:_IL_ZIP_________ Home Phone______________________
Father’s
Address (if different or indicate “same”) ____________________________________________
City___________________________
State:_IL_ZIP_________ Home Phone______________________
Parent E-Mail
address(es)___________________________________________________________________________
Do you want to
receive the e-Jordanaire Newsletter? ___
Yes ___ No Email address_______________________
*The newsletter will be sent only via e-mail.
Do you want to
receive PTA reminders/notices? ___
Yes ___ No
Names of
children at Marion Jordan:
____________________________________________Grade_____ Teacher ________________________________
____________________________________________Grade_____ Teacher________________________________
____________________________________________Grade_____ Teacher________________________________
____________________________________________Grade_____ Teacher________________________________
PTA Dues (Must
be PTA member to receive directory!)
Check ONE: _______Family Membership $9.50
_______Single Parent Membership $6.50
Make checks payable to Marion Jordan PTA.
Please return the form in an envelope marked “MJ PTA Membership” to
Marion Jordan by August 28th.
Any questions, please
call Mary Kating (847) 359-7314 and Doreen Dionne (847) 705-5829.
¿Preguntas? Llame a Anne Gruettner,
enlace bilingüe, al (847) 359-8006.
