John Diemer PTA Directory, Membership & Back to School Form

(All prices reflect Kansas Sales Tax, where applicable)

 

Make Checks Payable to “John Diemer PTA”

Membership Dues: $9.00 per person (includes complimentary student directory)

Member Name (First & Last): ______________________________________ @ $9.00   

Member Name (First & Last): ______________________________________ @ $9.00               

                                                                                                Total Membership Fee:                 $ __________

 

Additional Directories: ___________            @ $  4.00 each                                 $ __________

Diemer School Calendars: ________            @ $  3.50 each         Received □            $ __________

Yearbooks: __________                @ $13.00 each                             $ __________

Other with Description: ________________________________________    $ __________

Total Misc. John Diemer PTA Items: $ __________

 

Paid □              CHECK #:        __________                Total Amt Due John Diemer PTA:            $ __________

 

Questions? Contact            Diane Johnson, 383-2351, PTA President            Cathy Mintz, 341-8920 , Membership

                                    Sheri Potthoff, 642-7115, Yearbook        

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Please return Directory Information by Friday, September 1 even if you are not joining PTA.

(Enter as it should appear.  Specify “SILENT” if phone # is not to be included in the directory)

 

Please list each child attending John Diemer beginning Fall 2006

Child’s First & Last Name (as to be printed in Directory)	Grade	Teacher

 

     □   Please check here if parent names, phone, address & email for family remains the same as the 2005/2006 Directory.

     □   Please check here if  ONLY email for the family changes from 2005/2006 Directory.  Please provide ALL EMAIL information which is to be included in the directory.  Parent names, phone & address will remain the same as the 2005/2006 Directory.

     □   Please check here if  information is new or changed for the Directory.  In this case, only the information provided below will be used in the directory for parent names, phone, address & email.

 

Primary Parent/Guardian Names (First & Last): ____________________________________________

Street Address: __________________________________________________________________   

Zip Code: __________            Home Phone: _________________            Alternate Phone: __________________

Email Address: _________________________________            Alternate Email: ________________________

 

Secondary Parent/Guardian Names if applicable (First & Last): _________________________________

Street Address: __________________________________________________________________   

Zip Code: __________            Home Phone: _________________            Alternate Phone: __________________

Email Address: _________________________________            Alternate Email: ________________________

 

For Further Directory Information or if you have questions, contact:

Chris Rolston, 649-1962 or Kelli Choate, 649-3588, Directory

 

Distribution:                □ Brenda Holcomb, Treasurer                □ Chris Rolston/Kelli Choate, Directory                □ Cathy Mintz, Membership