BASIS North Central Membership Form
Please provide your student(s) name and grade.
Thank you for your support of the Booster programs. As a token of our appreciation, while supplies last, we have the following thank you gift: Please choose one option below.
I would like to receive a tote bag (valued at $5.25)
I would like to receive a yard sign (valued at $4.02)
Thank you but I don't need a gift.
Parent/Guardian #1 - Name
Parent/Guardian #1 - Email
Parent/Guardian #1 - Phone Number
Parent/Guardian #2 - Name
Parent/Guardian #2 - Email
Parent/Guardian #2 - Phone Number
Should be Empty:
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