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Check $ ________ Cash $________

Check # ________________________
Receipt # _______________________
Date: __________________________

Aiea Intermediate School Music Boosters
2014-2015 School Year
Beginning Orchestra, Intermediate Orchestra, Beginning Band, Intermediate Band


Name of Student Grade Instrument Course Name & Period
___________________ _____ ___________ ____________________

___________________ _____ ___________ ____________________

___________________ _____ ___________ ____________________

Name of Parent(s) or Guardian (s): _____________________________________________________
Mailing Address: _____________________________________________________________________
City: ____________ Zip Code: ____________ Phone # ___________________________________
Parent (s) or Guardian(s) Email: _________________________________________________________
Providing us with your email address will allow us to give you up to date information and
reminders on upcoming events.
The Music Boosters is looking for Volunteers. Get involved and join in the fun!
If you can help us out, please let us know by checking 1 or more of the items below.

___ Fundraising ____ Instrument/Equipment Transport
___Assist Treasurer ____ Board of Directors
___Event Coordination( Food Prep, etc.) ______ Others

Throughout the year, your membership dues and donations are used to help offset the cost
incurred by the Music Department and helps to pay for many of the activities that are provided for
the students who are enrolled in its music programs, The cost include (but are not limited to) :
concert hall rental, buses to transport students to performances and events, purchase and repair of
instruments, and much, much more. THANK YOU FOR YOU SUPPORT!
Please visit our website at www.aieamusic.com

Aiea Intermediate School Music Boosters Dues
Membership dues and donations are tax deductible

Annual Membership Dues: $20.00 Per Family

Membership: $_____________ Please make checks payable to: AIS Music Boosters Inc

Donation: $ _____________

Total: $______________

** A fee $20.00 will be assessed on all returned checks
*** Receipt will be provided