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2008 - 2009 MT. LEBANON HIGH SCHOOL PTSA
Membership/Directory Order Form
MEMBERSHIP #1 ($12.00 below) MEMBERSHIP #2 (Add $6.00 below)
Last Name First Name Last Name First Name
Street Address Street Address
Zip Code Phone Number Zip Code Phone Number
Complete the following for each student attending high school. Complete the following for each student attending high school.
STUDENT NAME GRADE HOMEROOM # STUDENT NAME GRADE HOMEROOM #
_______________ ______ ______________ _______________ ______ ______________
_______________ ______ ______________ _______________ ______ ______________
PTSA MBR’SHIP & DIRECTORY AMT DUE IS $12.00 2nd PTSA MEMBERSHIP AMOUNT DUE IS $6.00
(One directory is included with the $12.00 payment) (Subsequent memberships in family are $6.00 each)
________ PTSA Membership with One Directory: $12.00 each (Column 1 Above)
________ PTSA Additional Memberships/No Directory: $ 6.00 each (Column 2 Above)
________ PTSA Member Additional Directory: $ 6.00 each
________ Non-Member Directory: $ 12.00 each
$ Total Amount Submitted for PTSA Memberships and Directories
Notes:
- Membership and directory are included in one price.
- Dues are per person regardless of the number of children attending the High School. For example, for one parent of 3 high school children, total payment is $12.00. This includes one directory. Subsequent memberships in same family are $6.00. Additional directories for members are also $6.00.
- Please write one check for membership and directory payable to “Mt. Lebanon High School PTSA.”
- Membership forms and checks may be mailed to: PTSA Membership Chair: Lisa Borrelli Dorn, 301 Bower Hill Road, Pittsburgh, PA 15228
For additional information, contact Lisa Borrelli Dorn at (412) 341-6555 or at ldmcjdorn@aol.com
Attention: Faculty members wishing to join, please complete the following:
Last Name First Name Homeroom/Section
Total Due: $6.00 for faculty members/no directory
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