2016 - 2017 BLAKE PTSA MEMBERSHIP FORM
CONTACT INFORMATION
Student Name(s) and Grade(s):
Parent/Guardian:
Address:
City:
Email:
Zip code:
Phone:
ANNUAL MEMBERSHIP DUES
(Membership includes one student directory per family and is tax deductible!)
Parent/Guardian (1 adult): $25
Family Membership (2 adults): $35
$
$
Students, Staff, Alumni: $10
TOTAL MEMBERSHIP DUES
$
TOTAL $
DONATIONS
Please consider making a donation in addition to your membership dues. Any
amount is much appreciated. You can donate as an individual, family, or
business. Use your employer matching if available! 100% of your donation
is tax deductible and directly benefits Blake students.
Donation Amount
$
TOTAL DUES PLUS DONATION
MAILING ADDRESS
TOTAL $
Mail your completed form, including check, to:
Blake PTSA Membership, 300 Norwood Road Silver Spring MD 20905
PREFER TO SIGN UP ONLINE?
No worries! Go to: http://www.blakeptsa.org/join-online/ We accept PayPal.
QUESTIONS?
Contact Amy Creel
301-509-7301 or [email protected]
Join the Blake PTSA TODAY, and you will be automatically
entered to win one of many incentive prizes including a
$500 Target gift card!