1. Durant Road Middle School
Dolphin Athletic Booster Club
2011-12 Charter Membership
The NEW Dolphin Athletic Booster Club is a nonprofit volunteer organization working to supplement and
support the athletic programs by providing financial assistance to extracurricular athletics, thereby enhancing
the school programs at Durant Road Middle School. The club will provide assistance with uniforms and
equipment for the football, soccer, basketball, track, softball, volleyball, and cheerleading programs. Special
needs in the athletic programs are prioritized by each program for funding by the Dolphin Athletic Booster Club.
Join the NEW Dolphin Athletic Booster Club today as a Charter Member and help us get the club off to a great
start! To join please complete the information below and return this form along with your payment to the
Dolphin Athletic Booster Club. 2011-12 Individual Memberships will include admission to ALL DRMS HOME
sporting events from January 2012 through June 2012.
2011-12 Individual Membership – Each individual membership (adult or student) includes a season pass
that allows admission to all DRMS HOME sporting events from January 2012 through June 2012. Please
complete the following information:
# of 2011-12 Adult Memberships: X $20.00/each = $
# of 2011-12 Student Memberships: X $20.00/each = $
Please note: without Dolphin Athletic Booster Club Membership admission to all
DRMS HOME sporting events is $4.00/person (for 5 years and older)
Please select additional areas you are able to help support our DRMS Athletic:
Booster Club Planning/Administration
Fundraising
Donation of Items/Equipment (Details: )
Additional Monetary Donation* to the Dolphin Athletic Booster Club $
TOTAL ENCLOSED: .......................................................................................$
Please indicate type of payment enclosed: cash check
DONATIONS OF TIME, ITEMS, AND/OR MONEY ARE GREATLY APPRECIATED AND GLADLY ACCEPTED
*Monetary donations are tax deductible. Dolphin Athletic Booster Club Tax ID #90-0757842
Make checks payable to: DRMS Dolphin Athletic Booster Club (There is a $15 service charge on returned checks)
Parent Contact information (please print):
NAME: EMAIL:
NAME: EMAIL:
PHONE:
ADDRESS:
CITY/ZIP:
DRMS Student information (please print):
6th 7th 8th 1 2 3 4 Homeroom Teacher
NAME: Grade: Track:
NAME: Grade: Track:
NAME: Grade: Track:
If you have questions or want additional information please email dolphinathleticboosters@gmail.com
Please return form & payment to: Mr. Richard Barfield, Athletic Director, or Athletic Booster Club mailbox
in the school office
Membership Form 11-30-2011
BOOSTER USE ONLY: Date Rcv’d Cash _____ Check # Total Paid $
Monetary Donation Amt$
Recorded Date/By # of Memberships Membership fees Paid$