Marion Jordan Party Money and PTA Membership/Directory Order Form

Marion Jordan PTA

PTA Membership/Directory Order Form 2010-2011

(due Friday, August 20th)

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 and to be listed in 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 (unlisted).

_____I do NOT want to be a PTA member.

_____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_________________________________________________________________________________

Address______________________________________________________________________________________

City___________________________ ZIP______________ Home Phone__________________________________

Parent email address(es)_________________________________________________________________________

Names of children at Marion Jordan:

____________________________________________Grade_____

PTA Dues-(Must be a PTA member to receive directory!)

Check ONE: _______Family Membership $9.75

_______Single Parent Membership $6.75

Make checks payable to Marion Jordan PTA.

Any questions, please call Kelly Reynolds (847) 359-0464

¿Preguntas? Llame a Anne Gruettner, enlace bilingüe, al (847) 359-8006.