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		$ __________
Other with Description: ______________________________________			$ __________
Total Misc. John Diemer PTA Items:				$ __________

 

Paid :

CHECK #:

__________

Total Amount Due John Diemer PTA:

$ __________

 

Questions Contact: Roberta Pierce 649-6631 or Donna Brandt 642-6390 PTA Co-Presidents

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Please return Directory Information by Friday, August 31st 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 2007

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

 

___ Please check here if parent names, phone, address & e-mail for family remains the same as the 2006/2007 Directory.

 

___Please check here if ONLY e-mail for the family changes from 2006/2007 Directory.
Please provide ALL E-MAIL information which is to be included in the directory.
Parent names, phone & address will remain the same as the 2006/2007 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 & e-mail.

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

Street Address: _________________________________________________________________

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

E-mail Address: _________________________________ Alternate Email: _________________

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

Street Address: _________________________________________________________________

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

E-mail Address: _________________________________ Alternate Email: _________________

 

For Further Directory Information or if you have questions, contact: Hannah Baine 385-0398

Distribution: Veronica Ekasala, Treasurer; Hannah Baine, Directory; Cathy Mintz, Membership