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Please ensure information is accurate. Our membership coordinator will send membership information to Washington State PTA which will in turn mail out membership cards.

Name
 
Date Submitted (none current)
First Name

Last Name

Phone

Street

City

State

Zip

Email of adult #1

Adult #1 Relation to student

Name of Adult #2 (2-person membership)

Address of second adult (if different)

email of adult #2

Phone of Adult #2

Adult #2 Relation to student

Child #1

Grade #1 Pre-school
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade

Child #2

Grade #2 Pre-school
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade

Child #3

Grade #3 Pre-school
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade

Employer (Optional)

Volunteer and Donation Matching Yes
No