BAYARD MIDDLE SCHOOL

Please make check or money order payable to:  “Bayard Middle School PTA”

Please check membership type.  _____$5.00 per person   _____$9.00 per family

Member No. 1 ______________________________________________________

Address:  __________________________________________________________

Phone:  Day _______________  Evening_______________  Cell______________

E-mail Address: _____________________________________________________

Member No. 2 ______________________________________________________

Address: ___________________________________________________________

Phone:  Day ______________   Evening _______________  Cell _____________

E-mail Address: ____________________________________________________

Student’s Name _______________________________Grade (please circle) 6  7  8

PLEASE TAKE A FEW MOMENT TO ANSWER THESE QUESTIONS

If we need to contact you via telephone, what is the best number and time?

Number:  __________  Time:  (circle one)  Day  or  Evening

Do you have time to assist during the day if needed?

Yes  __________  No  __________  Maybe  __________

Are you willing to serve on a committee or the board of the PTA?

For PTA Use only:

Amount Received:  ______Cash  ______Money Order  (No Checks Please)

Membership Card (s) # issued:  (1) ____  (2) ____

Date card (s) issued/mailed:  ________

Membership   $________

Tax Deductibles  $________