Alan Shawn Feinstein Middle School of Coventry

                PTSA Membership 2009-2010

    $6.00 each adult/$4.00 each student

Please fill out the following information:

Name: _____________________________________________

Address: ___________________________________________

                ___________________________________________

Telephone: ________________   Alt. Phone ______________

Email Address: _____________________________________

Child’s Name: ______________________________________

Child’s Grade: ____________

Child’s Team Name: _____________________

Child’s Homeroom Number: ___________

Child’s Homeroom Teacher: __________________________

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PAID   Yes/No

AMOUNT _____________________

CASH OR CHECK