DUDLEY HIGH SCHOOL P.T.S.A.
 APPLICATION FORM

 P.T.S.A. membership is open to anyone who wishes to be a supporter of James B. Dudley High School.

 Annual Dues are $5.00. Donations may be made in any amount.Please complete the information below, detach and submit with payment.  

 Please check one

 ___Student ___Parent ___Alumni ___Other Supporter

 Please print neatly.

 Name_______________________________________

 Street Address________________________________

 City, State, Zip________________________________

 Phone Number________________________________

 E-mail Address________________________________

 Are you interested in volunteering for the P.T.S.A. at  Dudley or for other events? If yes, in what areas would you like to volunteer?
 ____________________________________________

 ____________________________________________

 If you have a child/children at Dudley, please list their names and grade level.

  Name Grade

  _____________________________________ _______

  _____________________________________ _______

  Thank you for your interest
and support
  of James B. Dudley High School !