Ada Merritt K-8 Center PTA MEMBERSHIP REGISTRATION FORM Registration Fee $10 Per Parent Checks made payable to Ada Merritt PTA
Ada Merritt K-8 Center PTA
MEMBERSHIP REGISTRATION FORM
Registration Fee $10 Per Parent
Checks made payable to Ada Merritt PTA
Registration Date: _____________ Parent _______Teacher _____ Student_______Other____________________
Middle Initial
Last Name
Mailing Address
Zip Code
Phone Numbers
Day:
Night:
Best Time:
E-mail Address
STUDENT/CHILD INFORMATION (If Applicable / For Local PTA Use)
Grade/Team
Student’s/Child’s Name
First Period Teacher
Relationship
STATISTICAL DATA
Questions:
a. Have you been a member of this PTA/PTSA within the last 12 months?
YES - NO
b. How many years have you been a member of this PTA?
c. In general, how many years have you been a member of PTA?
d. Are you a member of PTA/PTSA at another school?
(Optional) Please list other PTAs/PTSAs you are currently a member of:
1.
2.
3.
4.
e. May PTA email you notices about projects/issues the organization is working on?
(Optional) Ethnic/Cultural Information: Please check the category you best identify with
ÿ I do not wish to furnish this information
ÿ American Indian or Alaskan Native
ÿ Asian or Pacific Islander
ÿ Black/not of Hispanic origin
ÿ Hispanic/Latino
ÿ Multi-Ethnic
ÿ White/not of Hispanic origin
ÿ Other (Specify):
Country/Region of origin:
Preferred language to receive information:
everychild.onevoice.cadaniño.unavoz.chaqueenfant.unevoix.cadacriança.umavoz.ognibambinounavoce.everychild.onevoice
TO BE COMPLETED BY LOCAL PTA
LOCAL UNIT ID #
LOCAL UNIT NAME
CONTACT PERSON
PTA POSITION
BEST CONTACT PHONE #s
BEST TIME:
Email Address:
COMMENTS:
