Author: Kathy U Jones

Patriot Package $20.00
Package includes:
Membership in the PTA (additional membership available for $10)
Green Poplin T-shirt (Youth Sizes only, while supplies last!)
Parent Name:________________________________ Phone :_____________________
City:__________________ Zip code:__________ E-mail__________________________
Child’s Name _____________________Child’s teacher:______________ Grade:_______
Additional Teacher(s)______________________ T-Shirt Size: YS YM YL
Please make checks payable to Poplin Elementary PTA

PTA Membership Form
Please complete this form and return it to your teacher along with dues payment. Annual membership dues are $10 per person. Please note that e-mail addresses are for NCPTA database use only and will NOT be used for solicitation.

Name:________________________________ Phone #:________________________
City:__________________ Zip code:__________ E-mail:______________________
Credit membership to this class: Child’s teacher:_________________ Grade:______
Additional teacher(s)____________________________________________________
Child’s Name:__________________________________________________________
Name:________________________________ Phone #:________________________
City:__________________ Zip code:__________ E-mail:______________________
Credit membership to this class: Child’s teacher:_________________ Grade:______
Child’s Name:__________________________________________________________
Number of memberships purchased ______ x $10 =
Cash or check #________________
Make checks payable to Poplin Elementary PTA

Patriot Pride Package $35.00
Package includes:
Membership in the PTA (additional membership available for $10)
Tax deductible donation to the PTA
Poplin Elementary drawstring bag
Poplin Elementary water bottle
Poplin Elementary car Decal
Parent Name:________________________________ Phone :_____________________
City:__________________ Zip code:__________ E-mail__________________________
Child’s Name _____________________Child’s teacher:______________ Grade:_______
Additional Teacher(s)_______________________________________________________
Please make checks payable to Poplin Elementary PTA