Dillard Drive Elementary School PTA

“Membership & More”

Just Five Minutes & Five Dollars Can Make A Great Year!

OPTION 1 *Anyone Can Join the PTA! Join? YES / NO If YES - Fill in the Name(s) of the Adult Member(s)

Adult 1 – Last Name:

First Name:

Email:

Check One:

Single 1 Adult ($5) ___

Family 2 Adults ($10) ___

Adult 2 – Last Name:

First Name:

Email:

OPTION 2 *Are You a DDES Parent and Want to List Info in the Student Directory? YES / Don’t List Me in Directory

If YES – Fill in Parent/Guardian & Student Information Home email:_______________________________

Parent/Guardian Last Name (if not above):	First Name:	Parent/Guardian Last Name (if not above):		First Name:
Student’s Street Address:		City:	Zip:	Phone:

Last Name (List all students at DDES): 1.	First:	Teacher:	Grade:	*PTA Members Get a Free Directory. But parents can list info even if not a member! Got a Question? Contact Susan Uy suy.atnc@gmail.com
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OPTION 3 Go Dragonflies! Support School Spirit!

# Agendas _____ at $5.00 each = _____

# Car Magnets _____ at $5.00 each = _____

# T-shirts _____ at $10.00 each = _____

Welcome Back-to-School Donation $_____

TOTAL (inc. membership) $ ________

Painless Fundraising

We can help you Link-Up to DDES!

My Harris Teeter VIC Card #

(Print your VIC number)

Cash or Checks accepted. Please make checks payable to DDES-PTA. Return this form to your teacher. Membership card(s) and directory will be distributed in October. There will be a $15 fee for any returned checks.

* PTA USE ONLY *

Initial for Cash:_____ Write Check # _______