If you want to pay by check or purchase order, print this form and mail to address below. To pay by credit card, use our secure online payment form.
School District:		__________________________________________
School Name:		__________________________________________ (If individual school membership)
School Address: (Include City, State, Zip)		__________________________________________
		__________________________________________
School Contact:		__________________________________________
Phone:		__________________________________________
Purchaser's Billing Information
Purchaser's Name:		__________________________________________
Purchaser's Address:		__________________________________________
		__________________________________________
E-mail:		__________________________________________
Membership type: (Please check one)
________ Individual School ($80) ________ Home School ($65) ________ District ($55per school, must include all schools in the district, i.e. 12 schools x 50 = $660) Number of schools? _________ Please fill in total $ amount? _________
Total number of students enrolled: _________
Payment: ________  Check enclosed ________  Bill me and reference P.O. # __________________
Mail this form to:		Education Dept. / School Membership
		Rocky Mountain PBS
		1089 Bannock Street
		Denver, Colorado 80204
We're glad to have you join our members. Enjoy the benefits!

 

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