Pleasanton Middle School Parent Faculty Association (PFA) Working to benefit the parents, students and staff at PMS Membership & Voluntary Donation Form. PFA Membership Cashier Initials/Payment Type
Pleasanton Middle School Parent Faculty Association (PFA) Working to benefit the parents, students and staff at PMSMembership & Voluntary Donation Form
PFA MembershipCashier 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:
_____ 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 GradeHome 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