Membership Form

Cogburn Woods Elementary School

PTA Membership Enrollment and Enrichment Fund for 2009 / 2010

Member Information (Please print firmly)

PTA Member # 1 Name:                                                          CWE Staff For Individual Membership                                                                                check here      ___________

PTA Member # 2 Name:                                                                                     For Family Membership

Telephone Number:                                      E-mail Address:                                                                              Not for Publication, for PTA communications purposes only

Address                                                                 City:                              State:           Zip:

Student Name(s) – List all students

First                           Preferred                  Last                                      Grade/Teacher

Initial here if you do not want your students’ information published in the directory.        __________

Option # 1                           Join the PTA at the level of your choice
ð  Cougar Cub Package for families with Two Students                                                                                                                        Family PTA Membership  2 Yearbooks                                    Save $15 with purchase of package!             $75.00 2 Directories 2 Car Magnets 2 $5 Spiritwear Vouchers A $20 voluntary contribution to the CWE PTA Student Enrichment Fund	$_____________
ð  Cougar Cub Package for families with One Student      Family PTA Membership 1 Yearbook                                                   Save $5 with purchase of package!                    $50.00 1 Directory                                                                                                                                1 Car Magnet 1 $5 Spiritwear Voucher A $10 voluntary contribution to the CWE PTA Student Enrichment Fund	$_____________
Option # 2             Join the PTA a la carte and/or purchase items for additional children
ð Family PTA Membership (all family memberships include CWE PTA                                                 Car Magnet and directory)                                                    $  20.00 ð Individual PTA Membership                                                                                             $  10.00 ð  Student Directory   Must be a PTA member to purchase                                             ______ x   $    5.00   ð  2009 / 2010 Yearbook                                                                                    ______ x    $  15.00 ð  Additional CWE PTA Student Enrichment Fund Contribution      * PTA is a non-profit 501(c)3 organization and your  contribution is tax-deductible	$_____________   $_____________   $_____________   $_____________ $_____________
A La Carte Total	$_____________
Make your check payable to CWE PTA                                  Total Amount Paid	$_____________

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