CARROLLTON EARLY CHILDHOOD PTA

# MEMBER INFORMATION SHEET

2003-2004

Date ______________________

Name _______________________________ Spouse’s name________________________

Your birthdate (Month/Date) ____________ Email address _______________________________

Address _________________________________________________________________________

City / Zip ________________________________________________________________________

Home Phone ____________________________ Mobile Phone ___________________________

Children’s Names Birthdates (Month/Date/Year)

________________________________________ _____________________________________

________________________________________ _____________________________________

________________________________________ _____________________________________

________________________________________ _____________________________________

Sign below to give permission 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)

Signature _______________________________ No address No Phone # No E-mail

Check here if you DO NOT wish to receive CECPTA announcements via email

Check here if you would prefer to read your monthly CECPTA newsletter via internet instead of receiving it by mail

How did you find out about CECPTA? _________________________________________________

Please indicate your membership status for this year: New Member Alumni

Renewing Member Texas Life Member Grandparent

Do you have a friend who might also like to find out more about the Carrollton Early Childhood PTA?

Name _________________________ Address ________________________________________

What committees and/or activities might you be interested in helping with or participating in?

___ Bunco

___ Fundraising

___ Silent Auction

___ Hospitality

___ Host a Social

___ Parent Ed/Library

___ Playgroups

___ Publicity

___ Sunshine Committee

___ Telephone Committee

Please return this form along with a check for $25.00 (or $12 for Alumni or Grandparents) 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 ___ Nsltr Welc___ St Dues Pd ___