Montgomery knolls / pine crest PTA Membership and Directory information (School Year 2014-15)

See where to mail your form below, or join online at

FAMILY Details

Parent(s) or Guardian(s) Information
Parent 1 First Name: / Parent 2 First Name:
Parent 1 Last Name: / Parent 2 Last Name:
Parent 1 E-Mail: / Parent 2 E-Mail:
Parent 1Cell Phone: May we text you? Yes_ No_ / Parent 2 CellPhone: May we text you? Yes_ No_
Parent 1Home Phone: / Parent 2 Home Phone:
Student(s) Information
First Name: / Last Name: / Birth Year & Grade:
First Name: / Last Name: / Birth Year & Grade:
First Name: / Last Name: / Birth Year & Grade:
Primary Household Information
Address:
City/State: / ZIP / Home Phone:
Secondary Household (if applicable)
Name:
City/State: / Zip / Home Phone:

PTA/Schooldirectory LISTING

Please indicate below whether and to what extent the information on this form may be printed in the school directory.
 / Yes, please include ALL the information above in the directory.
 / Yes, please include my listing in the directory, but EXCLUDE the following items:
 / No, I don’t want to have any information included in the directory.
FREE MONEY FOR OUR SCHOOL!EASY CASH-FOR-SCHOOL REGISTRATION
Remember, even if you registered your card(s) last year, you must re-register each year for our school to receive credit.
 / Please register my Giant Bonus Card for Our School
Giant Bonus Card 12-Digit Number______First 3 Letters of your last name______
 / Please register my Safeway Club Card for OurPTA
Safeway Club Card Number (not Phone Number) ______
Check one: New Registration __ Renewal __ Full Name of Person who registered the Club Card ______
 / Please register my Target REDcard for Our School
Target REDcard Number ______Full Name listed on the card ______
PTA MEMBERSHIP FEES
 / Membership for one voting adult. See other side for list of membership benefits! / $10
 / Using a credit card? Please add $1 for processing fee. / $1
 / Donate $8 or more and be listed as a PTA BOOSTER in the Directory and on the website!Thank you! / $
Cash, or check made out to MKPC PTA TOTAL: / $
Return this application with your check made out to MKPC PTA to the Front Office of either school or mail it to:
MKPC PTA, c/o Pine Crest, 201 Woodmoor Drive, Silver Spring,MD 20901
Questions? Please contact our PTA Membership Chair, Rebecca Wilson at
Date Form Received: /  Cash / Check # ______