Pleasanton Middle School Parent Faculty Association (PFA) Working to benefit the parents, students and staff at PMS Mem

1. Pleasanton Middle School Parent Faculty Association (PFA) Working to benefit the parents, students and staff at PMSMembership & Voluntary Donation Form PFA Membership Cashier Initials/Payment Type _____ PMS PFA Membership - $25 ( Includes Directory) Choose one:_____ an electronic directory _____a hard copy directory $_________ __________ PERMISSIONDirectories are only provided to PFA family and faculty members. We must have your permission to include you in the directory. Please mark ONE of the two boxes below. _____Yes, please include the information below in the directory. ______No, please DO NOT include the information below in the directory. I acknowledge the directory information below is accurate. I understand that the directory is published expressly for the personal use of Pleasanton Middle School PFA Community. Initials: Voluntary Donation _____ PMS PFA Donation – suggested donation $200 per student (any amount is greatly appreciated and will be used to benefit all PMS students) $__________ __________ __________________________________________________________________________________________________________________________________________________________________________________________________________ DIRECTORY INFORMATION (please PRINT clearly) STUDENT INFORMATIONStudent Last Name Student First Name Grade Home Phone1.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ 2.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ 3.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ PARENT/GUARDIAN INFORMATION Father First Name Mother First Name Last Name ___________________________ _________________________ _____________________ Home Address (address, city, zip code) ________________________________________________________________________________________________________________ Home Phone Number Cell Phone Number ___________________________________ ______________________________________________________________ E-mail address ________________________________________________________________________________________________