Please complete the following form and read the Membership Dues Agreement.  By submitting your request you acknowledge that you have read and agree to the Membership Dues Agreement and Return Check Policy.  Once submitted, your information will be forwarded to the Director of Membership for processing.  You will receive a confirmation that your request has been received.

* = required information

First Name*:     Last Name*:     MI:

Second Member Name (if Applicable):     Last Name:     MI: 

Street Address*:

City*:     State*:     Zip Code*:

Phone Number*:     This is my Home Cell phone number*.

Would you like to be added to the mailing list for our e-Newsletter: Yes    No

E-mail Address:    

 

The classroom with the highest level of participation by March 15th earns a pizza party.

Please complete the following information so your child receives credit for your support.

If you have more than one child, please enter information for each child

so they get credit towards the Class Membership Pizza Party in March.

1.) Dent Student's First Name*:     Dent Student's Last Name*:

Grade of Student*:       Teacher's Name*:

2.) Dent Student's First Name:     Dent Student's Last Name:

Grade of Student:       Teacher's Name:

3.) Dent Student's First Name:     Dent Student's Last Name:

Grade of Student:       Teacher's Name:

4.) Dent Student's First Name:     Dent Student's Last Name:

Grade of Student:       Teacher's Name:

 

Are you interested in volunteering? *   Yes    No

Are you interested in making a monetary donation? *   Yes    No

 

I will send in $.00 along with my membership dues.

Which level of membership would you like to join*:   

Learn more about our levels of membership by clicking here.

Membership Dues Agreement

I agree that I will submit my membership dues by cash, check, or money order, payable to LMDPTA, Inc., within three business days of submitting my membership request.  Membership dues may be mailed to the school or sent with your child to the school for placement in the PTA mailbox.  I understand that if my membership dues are not received within seven business days, my request for membership may not be processed in a timely manner. 

 

I have read and agree to the Return Check Policy.*

 

 

Don't forget to print this page for your records BEFORE you submit your request.

    

After completing your entries you will be taken to a site to verify your information before they are accepted.

 

Thank you for your interest in LMDPTA, Inc.

 

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