Office: Treasurer
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
Office: Co-President (if applicable):
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
Office: Co-President (if applicable):
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
Office: _________________________________________
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
Office: _________________________________________
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
Office: _________________________________________
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
Office: _________________________________________
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
Office: _________________________________________
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
District or Borough Presidents’ Council Representative:
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
District or Borough Presidents’ Council Alternate (PA/PTA’s voting member to the Presidents’ Council in the absence of the Representative):
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate Presidents’ Council. |
home telephone: |
Principal/Designee’s Name: _____________________________________________________________
Principal/Designee’s Signature: _________________________________________________________
Date Signed: _______________________________________________
4
School Leadership Team: Elected Parent Members:
Please use the section below to record the names and contact information for parent members elected
to the School Leadership Team
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate District Leadership Team. home telephone:
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate District Leadership Team. home telephone:
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate District Leadership Team. home telephone:
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate District Leadership Team. home telephone:
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate District Leadership Team. home telephone:
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate District Leadership Team. home telephone:
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate District Leadership Team. home telephone:
Name:______________________________________________________________________________________
Address: ____________________________________ Borough: _________________________ Zip:_________
Home Telephone:______________________________ Business Phone: ______________________________
E-mail: _____________________________________________________________________________________
By initialing the boxes, I authorize OFEA to release my home telephone number and email address to the
appropriate District Leadership Team. home telephone:
Principal/Designee’s Name: _____________________________________________________________
Principal/Designee’s Signature: _________________________________________________________
Date Signed: _______________________________________________
6