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This is a remittance form for the Springfield PTA Council.
Renew lease?

(555) 555-5555
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 $
aed126ad8341b629f3b19ee7f3e9d4f7c83ebfe5
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