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This is a remittance form for the Springfield PTA Council.

Date Submitted
Check #

Per Capita Dues (due monthly)
Members Count
Fee per Member $
Member Dues $
One time annual Council Dues (due 11/1)
Annual Dues $
Annual Council Dues $
Donation (optional)
$
Total Check Amount $
3ba937dd2c0721e9e1b9eb3846ceed48f45de3bb
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