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ROBINSON PTSA
MEMBERSHIP FORM

Name(s) (please print)_________________________________________________________________________

Address _____________________________________________________________ Phone_______________

_____ Members at $12.00 per member ($10.00 is tax deductible)

_____ Donation (100% tax deductible, 100% goes to Scholarships)

_____ Student members at $5.00 (grades 9-12) – Name/Grade _______________________________________

TOTAL $ Amount __________

Make check payable to "Robinson PTSA” – STAPLE your check to this Form and Mail to:

Robinson PTSA, 5035 Sideburn Road, Fairfax, VA 22032

Thanks for your support J