New Membership Form

Name ___________________________________________________________________ Phone __________________________________________________________________ Address ________________________________________________________________ City ___________________________________________________________________ State __________________________________________________________________ Zip ____________________________________________________________________ Mark your membership choice and which medallion(s) you prefer: Individual $30 _____________ (1 medallion) Family $60 _____________ (2 medallions) Patron $100 _____________ (2 medallions) Sponsor $250 _____________ (2 medallions) Benefactor $500 ____________ (2 medallions) Please note: Patron, Sponsor and Benefactor memberships will be recognized in the Poland Bulldogs Football Program. North Elementary ___________ Bulldog Mascot ___________ Union School ___________ McKinley School ___________ Dobbins School ___________ The New High School ___________ The Little Red School House ___________

Please print this page and mail it to: Poland Schools Foundation for Educational Excellence P.O. Box 5217 Poland, OH 44514-0217