ROUND MEADOW ANNUAL FUND 2016-17
“EVERY CHILD BENEFITS”
PARENT NAME: __________________________________________________________________________________
ADDRESS: ________________________________________________________________________________________
EMAIL: ________________________________________________ PHONE: __________________________________
________________________
CHILD'S NAME
__________________
_________
TEACHER
________________________
CHILD'S NAME
GRADE
__________________
_________
TEACHER
________________________
CHILD'S NAME
GRADE
__________________
_________
TEACHER
GRADE
Blue Level $600 x ______ (# of children) = $ ___________
□ check here for monthly payment plan at $630
Incentives: Round Meadow car magnet and grocery bag
Silver Level $1,000 x ______ (# of children) = $ ___________
□ check here for monthly payment plan at $1,030
Incentives: Blue items, plus Movie Night Advertisement or Dedication
Gold Level $2,000 x ______ (# of children) = $ ___________
□ check here for monthly payment plan at $2,030
Incentives: Blue and Silver items, plus Ride the Fence Banner
Platinum Level $3,000 x ______ (# of children) = $ ___________
□ check here for monthly payment plan at $3,030
Incentives: Blue, Silver & Gold items, plus 2 tickets to Round Meadow event of choice
EVERY DOLLAR COUNTS, LIST OTHER AMOUNT HERE:
□ Credit Card
$______________
Please make your payment at Pay4SchoolStuff.com
If you are unable to pay online:
□ Check Enclosed (Please make checks payable to Round Meadow PFA)
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______________________________________________
CARD NUMBER
______________________
EXP DATE
______________
CCV NO.
______________________________________________
NAME ON CARD
___________________________________________
SIGNATURE
THANK YOU FOR YOUR SUPPORT! DONATIONS ARE TAX DEDUCTIBLE: TAX ID #23-7441811