JOIN THE WEBER HSA TEAM FOR 2003-2004

Weber hSa, Inc.

a 501(3) (c) Not-For-Profit Corporation

52 Campus Drive, Port Washington, New York 11050

HSA MEMBERSHIP FORM 2010-2011

Dear Weber Parents/Guardians:

Middle school is an important experience for our children. It is a time when good communication between home and school is essential. Membership in the Weber HSA is a great way to stay involved and keep informed during these important years. All members are welcome to attend our monthly meetings, usually held on Wednesdays either from 8:45 to 10 a.m. or from 7:30 to 9:00 p.m. in the Weber library.

A suggested donation to join the Weber HSA is $25.00 per family. Your dues are our primary source of funding. Your donation will provide financial support for the Cultural Arts programs, the Bulletin Board (our newsletter), student scholarships, and other enrichment experiences designed to enhance our children’s educational programs. Your $25.00 donation also entitles you to a Weber Middle School Student Directory which will be mailed to you in November. Additional donations to subsidize our activities would be greatly appreciated. Checks should be made payable to: Weber HSA, Inc. Please note that all donations are tax-deductible to the fullest extent of the law. As required by IRS regulations, we advise you that no goods or services will be provided to you in exchange for your donation.

We hope that you’ll show your support by joining the Weber HSA. Thank You!

If you have any questions, please contact the Weber HSA Co-Presidents:

Emily Beys 944-8487 emilybeys@yahoo.com

Mariann Dalimonte 883-1426 mjdalimonte@msn.com

Please return this form with your donation in the enclosed envelope to the VP of Membership, Mary Alice Kohs, 15 Tibbits Lane, Port Washington, NY 11050 or, to the Membership Committee in the Main Lobby during Open House in September. Please don’t forget to give us your email address – it’s an important communication tool for the Weber HSA.

__________________________________________________________________________________

Student Name (First & Last) ___________________________________________ Grade in Sept. 2010 ______

Parent/Guardian Names __________________________________________________________

Address ________________________________________________________________________

Telephone # _____________________ Parent Email ____________________________________

(PLEASE PRINT VERY CLEARLY)

Donation ($25.00 per family) $ _________________

Additional contribution $ _________________

Total enclosed $ _________________