MCCPTA Blue Book Directory

Entry Form

 The following information will appear in the 2012-2013 MCCPTA Directory and names will be placed on our mailing lists. Please fill this form out in its entirety and return it to the MCCPTA office BY THE END OF JUNE. Additional information may be submitted at any time.

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PTA:

School Name:

School Principal:

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PTA President (for the upcoming 2012-2013 school year):

Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

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President Elect (this refers to someone who may be serving in a Co-President role in the 2012-2013 school):

Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

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MCCPTA Delegate (s):

Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

Designated Alternate (Please do not use President as Alternate):

Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

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Treasurer:

Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

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The information below will not appear in the Blue Book but is collected so that we can communicate directly with other PTA Board members.

Vice President (s): (If you have more than 2 vice-presidents, please email their information to office@mccpta.com)

1. Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

2. Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

Membership Chair:

Name:

Address:

Street:                         City:                 ZIP:

Phone: E-mail: Fax:

Thank you for your cooperation in this matter.