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membership form 2011 adult member or student member m f m f child s name m or f school building grade/teacher child s name m or f school building grade/teacher child s name m or f school building grade/teacher email address home work cell preferred method of contact circle one email or phone are you interested in joining a ptsa committee or volunteering circle one yes or no please use separate forms for each member joining and remember anyone can join each membership is $5 thank you official use only payment method cash check date received received by membership card ptsa membership receipt amount paid check or cash date card if returning by mail please mail to ccs special education ptsa nyspta charter binder revised august 2008

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1732 fyler rd chittenango ny 13037 you can also return to any building pta/ptsa president in the district thank you nyspta charter binder revised august 2008

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