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All dues payments to the NJPTA Office require a completed Membership Dues Payment Schedule Form. Payments cannot be processed without this form and may otherwise be returned to the attention of your President. Please mail the form and a check payable to NJPTA to the address listed below New Jersey PTA 8 Quakerbridge Plaza Suite F Mercerville NJ 08619 609-587-0100 For Office Use Only Check Date Received Account Balance Amount Received MS ACCESS. 2013-2014 SCHOOL YEAR MEMBERSHIP DUES PAYMENT SCHEDULE This form can be completed electronically calculating dues amount and/or printed to complete. PLEASE REMIT FORM/PAYMENTS BY THE 15TH OF EVERY MONTH Please Choose PAYMENT MADE IN Always give EACH INDIVIDUAL MEMBER one 1 membership card as a receipt for their dues. Local PTA Number Local PTA Name County TREASURER Daytime Evening Address City Zip Code MEMBERSHIP CHAIR E-Mail Please enter the number of new members and calculate the amount due carefully. Multiply the number of new members by 4. 00 to get the total and submit that amount. NO REFUNDS OR CREDITS WILL BE ISSUED New Members Enrolled since last scheduled payment Total Dues Payment 4. 00 per member 2. 25 National PTA Dues/ 1. 75 New Jersey PTA Dues REMEMBER Submit a payment only for the amount of cards you have physically sold Do not submit a payment for cards in advance of actual sale. Your statement will reflect outstanding cards until payment and/or returns are received at the State Office. UNUSED AND/OR VOIDED CARDS ARE TO BE RETURNED BY JUNE 2 2014 USING THE ENROLLMENT BREAKDOWN AND UNUSED/VOIDED MEMBERSHIP CARD REPORT NOT THIS FORM. 2013-2014 SCHOOL YEAR MEMBERSHIP DUES PAYMENT SCHEDULE This form can be completed electronically calculating dues amount and/or printed to complete. PLEASE REMIT FORM/PAYMENTS BY THE 15TH OF EVERY MONTH Please Choose PAYMENT MADE IN Always give EACH INDIVIDUAL MEMBER one 1 membership card as a receipt for their dues. PLEASE REMIT FORM/PAYMENTS BY THE 15TH OF EVERY MONTH Please Choose PAYMENT MADE IN Always give EACH INDIVIDUAL MEMBER one 1 membership card as a receipt for their dues. Local PTA Number Local PTA Name County TREASURER Daytime Evening Address City Zip Code MEMBERSHIP CHAIR E-Mail Please enter the number of new members and calculate the amount due carefully. Local PTA Number Local PTA Name County TREASURER Daytime Evening Address City Zip Code MEMBERSHIP CHAIR E-Mail Please enter the number of new members and calculate the amount due carefully. Multiply the number of new members by 4. 00 to get the total and submit that amount. NO REFUNDS OR CREDITS WILL BE ISSUED New Members Enrolled since last scheduled payment Total Dues Payment 4. Multiply the number of new members by 4. 00 to get the total and submit that amount. NO REFUNDS OR CREDITS WILL BE ISSUED New Members Enrolled since last scheduled payment Total Dues Payment 4. 00 per member 2. 25 National PTA Dues/ 1. 75 New Jersey PTA Dues REMEMBER Submit a payment only for the amount of cards you have physically sold Do not submit a payment for cards in advance of actual sale.

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