Student Application

for
Blue Ridge Parent Teacher Student Association
(PTSA)
Name:____________________________________Date:________
Address:______________________________________________
Phone number:_________________________________________
Email address(our preferred method of contact):_____________________
Grade:__________________________________
How involved do you want to be in the Blue Ridge PTSA?______
_____________________________________________________
Membership options: Please check amount paid.
___$5- PURPLE membership
___$35 or higher- GOLD membership(The gold membership gives you the
opportunity to make a larger donation. It also gives you the opportunity to donate your
money instead of your time. If you are too busy to help us with our efforts, become a
gold member and specify that you are not interested in giving your time.)
___Enter amount if more than $35 here___________
Mail form and check payable to:
Blue Ridge PTSA
1200 W White Mountain Blvd.
Lakeside, AZ 85929

Check out our PTSA blog at: www.brptsa.blogspot.com

We welcome your input. Please write your comments below: