Double Membership

Check all that apply. Select all that apply Parent/Guardian Faculty/Staff Student Community Member Other

Primary Member's Full Name (First and Last Name) *

For Family Membership please add names of all additional members. (Seperate names of additional family members with a comma. If there are none, please type none in the text field.) *

Email Address *

Phone Number *

Physical Address *

Mailing Address (please include city, state, and zip code) *

List all students and their grade level/s that will be under your membership (Separate names and grade levels with a comma. If there are none please type none in the text field.) *

Throughout the school year photos and videos may be taken of members. By selecting 'Yes, Allow' you grant permission for PTA to use you, your family, or your student's image, work, accomplishments, etc. to be used on our website, social media, etc. Select all that apply Yes, Allow No, Do Not Allow

Are you available to volunteer with PTA? Select all that apply Yes No

If you are available and willing to volunteer what are your best skills to offer PTA? (examples: moving boxes, manning an event table, calling members, running an event, typing, fundraising, writing, childcare, passing out lunches, bake sale, etc...)

Grand Canyon PTA Sponsorship Levels Select all that apply Years Sponsor (+ $10.00) Decades Sponsor (+ $20.00) Centuries Sponsor (+ $50.00) Millennia Sponsor (+ $100.00) 10,000s Sponsor (+ $250.00) 100,000s Sponsor (+ $500.00) Millions Sponsor (+ $1,000.00) Billions Sponsor (+ $3,000.00)

Additional Donation: Trail of Time PTA Sponsors (All Sponsors will be recognized and listed in the PTA eNewsletter and on our PTA website.) Select all that apply Years Sponsor (+ $10.00) Decades Sponsor (+ $20.00) Centuries Sponsor (+ $50.00) Millennia Sponsor (+ $100.00) 10,000s Sponsor (+ $250.00) 100,000s Sponsor (+ $500.00) Millions Sponsor (+ $1,000.00) Billions Sponsor (+ $3,000.00)

Donate in the name of a friend or loved one (optional)

I _____ release my name for recognition. Select all that apply DO DO NOT

Double Membership

Description