MCCPTA DUES PAYMENT VOUCHER FOR 2005-06

 

Return bottom portion to the MCCPTA office at: MCCPTA, North Lake Center, 15101 Bauer Drive, Rockville, MD 20853 (or through the Pony mail system to MCCPTA, North Lake Center).  Keep the top portion for your records.

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                              MCCPTA Dues - Initial Payment - Due November 1, 2005

 

Name of PTA:___________________________________________________

 

 

Number of Member:  Adults______   Teachers_______  Students______   Total______

 

 

Amount Remitted ($0.75 per member):  $__________   Check#______

 

 

PTA Treasurer:_______________________ Phone Number_____________

 

 

Keep this portion for your records.

 

                              MCCPTA Dues - Initial Payment - Due November 1, 2005

 

Name of PTA:___________________________________________________

 

 

Federal Tax ID Number:________________________

 

 

Number of Member:  Adults______   Teachers________   Students______   Total______

 

 

Amount Remitted ($0.75 per member):  $__________   Check#______

 

 

PTA Treasurer:_______________________ Phone Number_____________

 

 

For MCCPTA Office Use Only:

 

Delegate Card Numbers:

 

Date:

 

Return this portion to MCCPTA