ONLINE PURCHASE VERIFICATION FORM  

Complete this form ONLY if you purchase your PAC membership through the ASB Webstore.

Attach your online payment receipt to this form and submit both during Registration or to ASB Headquarters (R1) during the last 20 minutes of lunch (Monday–Thursday).

If you purchase your PAC membership in person (cash, check, or digital payment at school), no paper form is required. An ASB student will complete your electronic registration for you.

Student First Name: __________________  Student Last Name: __________________

Grade: ☐ 6  ☐ 7  ☐ 8 Student ID #:______________________________

Student OPUSD Email____________________________  Parent Email_______________

Select Your PAC Membership Contribution:

☐ $50 PAC Membership per student ($55 in September) Supports one MCMS student and helps fund ASB-sponsored events, activities, and experiences.

☐ $100 PAC Sponsor Membership per student
Helps support your student and provides an additional student the opportunity to participate in the Panther experience.

☐ Additional Support: $50 increments per student
$____________
Additional contributions help ASB create even more events, activities, and memorable experiences for our entire MCMS community.

*****A $100+ membership contribution per student receives one complimentary MCMS spirit item (while supplies last).

Digital payments include a small additional fee to help cover processing costs.

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                  For ASB Use Only: Receipt Verification

☐ Yes Date Verified ___________          Verified By _________________

Verified Amount Paid:_________   Entered into ASB database:   ☐ Yes