CARROLLTON
EARLY CHILDHOOD PTA
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 emailCheck 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
Date Rec’d______ Check #____ Mapsco___ Letter Sent____ Card ___ Nsltr Welc___ St Dues Pd ___