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Springfield Parents for Public Schools

SPRINGFIELD ILLINOIS CHAPTER

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SPPS Membership Form

Name: ______________________________________________________

Please list all adults if a family membership

Address: ____________________________________________________

_______________________________ ZIP _________________

Home Phone: _________________________________________

Work Phone: _________________________________________

E-Mail Address: ________________________________________

# of Children: _________________________________________

Schools they attend: ___________________________________

Please contact me about involvement opportunities: _________ yes

_____ Single Membership $5 for a year or $10 for 2 years

_____ Family Membership $10 for a year or $20 for 2 years

_____ Student Membership $2 for a year or $4 for 2 years

_____ Corporate Membership $25 annual membership fee

Donations are always appreciated - $10____ $25____ $50____ Other _____

Please make checks payable to Springfield Parents for Public Schools

Print this form and mail to: Springfield Parents for Public Schools

P. O. Box 7452

Springfield, IL 62791