Please secure your payment to this form
and return back to your child’s teacher.
Thank you for supporting Jones Dairy.
Go Panthers!
2013- 2014 Jones Dairy Elementary
PTA Membership Application/Direct Donation Option
WELCOME to JONES DAIRY ELEMENTARY! We hope that your experience within our
JDE family over the next year will be a positive, fun filled, journey and that your child/children
will share those same experiences as well. As a “ School of Excellence”, each year, we start
fresh and we wouldn’t be able to do all that we do throughout the school year without YOUR
support, whether that be as a PTA member or whether that be through your direct donation.
 Option #1) PTA Membership Application: The cost of membership is $7.00. The JDE
PTA forwards $4, to the National & NC PTA for support & the remaining $3 is used for
Jones Dairy PTA for efforts here at our school. As part of the JDE PTA family, you
would be entitled to participate or vote in business meetings of the general membership
including the election of officers. You are entitled to National PTA membership
discounts. You will be e-mailed a monthly school newsletter.
 Option #2) Direct Donation Option: 100% of proceeds go back to JDE and you receive
a car magnet and window decal for showing your support for our school!!! You will be
e-mailed a monthly school newsletter.
 Option #3) Sign up for BOTH: PTA Membership & Make a Direct Donation: You will
receive both a PTA membership, a window decal, car magnet and a e-newsletter.
Please list information for one child so that we can get the
membership cards and/or magnets to you:
Child’s First & Last Name: ____________________________
Teacher:_____________Track: ______Grade:______
Option 1: JDE PTA Membership
Yes I want to be a PTA Member so I can support my school and local PTA efforts.
Please circle which type of membership you want: (Single/Family)
Cost: Single Membership - $7.00 (one card)
Cost: Family Membership - $14.00 (2 cards)
(Please make checks out to: JDE PTA. NO magnet or window decal given with this option)
First Name: _________________________Last Name:_________________________
If Family Membership please list the FIRST & LAST name for the 2nd card:
First: ______________ Last: ___________________
Email address:__________________________________________
Option 2: Direct Donation
I do not want to be a PTA member but want a 100% of my gift to go directly to Jones Dairy
Elementary PTA and will receive a window decal and a magnet to display my spirit.
Amount of Direct Donation: ___$10___$15___$20____Other
(Make checks out to: JDE PTA)
First Name:_________________________Last Name:_________________________
Email address:__________________________________________
Option 3: Sign up for Both
If you choose this option, please fill out BOTH Option # 1 and Option #2 above. You will
receive a PTA membership card, window decal and car magnet.
Thank you for your support!
For PTA Use Only: Date______
____________
Amnt Recvd:___________Cash:_________Check#: _______________Recvd By:
For PTA Use Only: Date:________Amount Recvd:___________ Cash:_______ _Check #:___________Received By: ____________