CARROLLTON EARLY CHILDHOOD PTA
MEMBER INFORMATION SHEET
2002-2003
Date ____________________
Name ______________________________ Your Birthdate _____________
Spouse’s Name _________________________________________________________
Address _________________________________________________________
City / Zip _________________________________________________________
Phone ______________________ E-Mail Address _____________________

Children's Names and Birthdates
___________________________ ________________________
___________________________ ________________________
___________________________ ________________________
___________________________ ________________________
Sign below to be included in our Membership Directory (If you would like to be included but do not want your address, phone number or E-mail address to be printed, please specify)
_______________________________ No address No Phone # No E-mail

Check here if you do not wish to receive CEC PTA announcements via E-mail

How did you hear about the CEC PTA? ______________________________________

Please indicate your membership status for this year: New Member Alumni
Renewing Member Texas Life Member Grandparent

What committees and/or activities would you be interested in this year? (Put a "P" for participate in, an "H" for help out with, or a "B" for both)
___ All Around Dallas ___ Membership Coffees ___ Publicity ___ Book Club ___ Family Night ___ Members Night Out ___ Scrapbooking Club ___ Bunco ___ Parent Educ/Library ___ Silent Auction ___ Community Service ___ Fundraising ___ Parties ___ Sunshine Committee ___ Craft Club ___ Hospitality ___ Playgroups ___ Telephone Committee

Are you interested in hosting a Membership Coffee? Yes No Month preference ___________

Please return this form along with a check for $25.00 made payable to CECPTA to:
Amy Turner
1005 Janus Drive
Carrollton, TX 75007-2879
(972) 394-8787

#### For Office Use Only

Date Rec’d____________ Check #__________ Mapsco_________ Letter Sent____ Card Issued___