Treasurer'S Monthly Remittance Form
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1Treasurer’s Monthly
Remittance Form
Copy form as needed.
Don’t forget to email your membership roster.
Questions?
or 734-975-9500.
Unit Name: __________________________________________ Michigan ID# ___________ Region: _____
Council: ___________________________________________________ Month: ____________ Year: _____
_________________________________________________________________________________________
School Address
City
Zip Code
_________________________________________________________________________________________
Treasurer’s Name
_________________________________________________________________________________________
Street Address
City
Zip Code
_________________________________________________________________________________________
Telephone
Email Address
_________________________________________________________________________________________
President’s Name
_________________________________________________________________________________________
Street Address
City
Zip Code
_________________________________________________________________________________________
Telephone
Email Address
NUMBER OF INDIVIDUAL/STAFF/STUDENT MEMBERS .......... _____ X $5.50
= $ ___
NUMBER OF BUSINESS MEMBERS ................................................ _____ X $33.00 = $ ___
FOUNDER’S DAY GIFT .................................................................................................. + $ ___
TOTAL REMITTANCE .....................................................................................................
$ ___
Membership Roster Submitted By:
Email
Attached
(Excel file preferred)
Return completed form to:
For Office Use Only:
Michigan PTA
Received Date: ________ Amount: _______
1390 Eisenhower Place
q Check #: ___________________________
Ann Arbor, MI 48108
Processed By: ________________________
Notes: ______________________________
____________________________________
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