GRASSO TECH PARENT FACULTY ORGANIZATION MEMBERSHIP FORM

Student's Name(s):___________________________________________________________________

Student's HR(s):__________________________________   Student's Grade(s):__________________

Parent/Guardian Name:_______________________________________________________________

Address                          _______________________________________________________________

Phone Number   _______________________________________________________________

Enclosed is my check for $5.00 for annual dues.   Mail to: Grasso Tech PFO, 189 Fort Hill Road, Groton, CT 06340.   If you have any questions please call John Blake at 441-0359, or Maggie Delaporta at 445-3822.