7443 US Hwy. 90 West
Lake City, Florida 32055
Telephone: 386-752-8874
Fax: 386-752-9453

PTA FUND RAISER
Name:__________________________________________________Date:____________________________

Address:________________________________________________Telephone:_______________________
    
     ________________________________________________



Name(s) of children enrolled in Blake:


Name:___________________________   Age:_________  Cluster:__________________________________

Name:___________________________   Age:_________  Cluster:__________________________________

Name:___________________________   Age:_________  Cluster:__________________________________

Name:___________________________   Age:_________  Cluster:__________________________________


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Please choose one of the following for your PTA Fund Drive Pledge:









(All payments qualify as a 501c.3 Tax deductible donation. Please make your check
payable to The Blake School PTA. Thank you for your strong support!)


Signature:________________________________________________________Date:____________________



Member of Florida State and National Parent Teacher's Association


o One payment of  $100  (Due September 1st)

o   Two payments of  $50  (Due September 1st  /  Due January 1st)