PFA Membership Cashier Initials/Payment Type

1. Pleasanton Middle School Parent Faculty Association (PFA) Working to benefit the entire student & teacher community of PMSMembership & Voluntary Donation Form PFA Membership Cashier Initials/Payment Type _____ PMS PFA Membership - $25 Includes Directory and Newsletter Choose one: _____ an electronic directory _____a hard copy directory $_____________ __________ PERMISSIONDirectories are only provided to PFA family and faculty members. We must have your permission to include you in the directory. Please mark ONE of the two boxes below. _____Yes, please include the information below in the directory. ______No, please DO NOT include the information below in the directory. I acknowledge the directory information below is accurate. I understand that the directory is published expressly for the personal use of Pleasanton Middle School PFA Community. Initials: Voluntary Donation _____ PMS PFA Donation – suggested donation $200 per student (any amount is greatly appreciated and will be used to benefit all PMS students) $______________ __________ __________________________________________________________________________________________________________________________________________________________________________________________________________ DIRECTORY INFORMATION (please PRINT clearly) ____Our child / children were in last year’s directory STUDENT INFORMATIONStudent Last Name Student First Name Grade Home Phone1.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ 2.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ 3.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ PARENT/GUARDIAN INFORMATION Last Name (Household #1) Mother First Name Father First Name Cell phone with carrier ___________________________ _________________________ _____________________ __________________________ Home Address (address, city, zip code) E-mail address ____________________________________________ _________________________________________________________ Last Name (Household #2)Mother First Name Father First Name Cell phone with carrier _____________________________ _________________________ ______________________ ____________________________ Home Address (address, city, zip code) E-mail address _______________________________________________ ___________________________________________________________