Darnestown Elementary School PTA Membership Form: 2009-2010

WHY JOIN THE PTA?
It is an advocacy group for our schools and our children. Our local PTA is an affiliate of the Montgomery County (MCCPTA), Maryland (MDPTA) and the National PTA. By joining not only do you support education in our school, but your voice is added to those of parents nationwide. Your dues help fund valuable PTA services at DES such as school social events, media center books and technology, science education and cultural enrichment programs and the PTA Directory.

Help us reach or very important goal of 100% Membership this year!
Please complete and return this form to school with your child, or return at Back-to-School Night. Contact Deborah King Firestine (301-928-3369), or deborahjking@hotmail.com)  if you have any questions.  As a current PTA member, you will receive a DES directory when it is published in the Fall. Only PTA members receive a directory. Please return form no later than September 30 in order to have your information published in the Directory.

Membership Information (Please make checks payable to DES PTA) :
____    Family Membership ($20.00)
____    Single Parent ($10.00)
____    Staff Membership ($10.00)
____    Patron Membership ($75.00)
In addition to a family membership, you receive special mention in the directory and your tax-deductible contribution will go directly toward supporting the PTA and its programs.  Please list my Patron Membership in the directory as follows (family name, individual name, or business name):  _____________________________________________________________________________________

(If you would like to join the PTA, but cannot afford to pay the membership dues, please check here ____. Funds are available to sponsor your membership and we encourage all families to join).

Directory Information:
Last Name: _________________________  Parents’ Names: _____________________________________________

Children’s Names, Grades, and Classroom Teachers:

Please check one:
               _____   Please print the same contact information as last year (with updated child information)
               _____   Include our family in the directory with the following contact information:

Address: (Please include Zip Code)______________________________________________________________________________________________________________
Phone: ________________________________	E-mail: ___________________________________________________
Cell Phone: ___________________________	Additional Cell or e-mail address: ___________________________ ________________________________________________________________________

PLEASE CHECK HERE IF YOU WOULD NOT LIKE YOUR INFORMATION PRINTED IN THE DIRECTORY ______
The Directory will contain ALL families at DES unless you request your information to be withheld.

Harris Teeter, Safeway, and Giant Information:
Please help raise money for our school by listing your Grocery Store cards below.  The school gets cash back every time you shop at no cost to you!  Please note that we need the actual card number (not a telephone number). Even if you designated DES as your school last year, you have to re-designate it again this year.  You can also register your Harris Teeter card when you check out at the store – just tell the cashier you would like link your VIC card to DES. If you have questions about this program, please contact Peter Moyer at 301-963-1280, or summoyer@comcast.net.

Harris Teeter Card # ________________________ Safeway Card # ________________________  Giant Card # _____________