UPPA New Member Form

New Member            Returning Member            Sustaining Member

                                                                        First Name     Last Name         Spouse's Name

                                                                            Address             Zip Code

                                                                   Email Address           Birth Month/Day /

                                                                     Home Phone         Cell Phone         Work Phone

Children(s) Information

Name                                Birthday (MM/DD/YYYY)          Boy        Girl     Year starting kindergarten or current grade                                         Name                                Birthday (MM/DD/YYYY)          Boy        Girl     Year starting kindergarten or current grade                                          Name                                Birthday (MM/DD/YYYY)          Boy        Girl     Year starting kindergarten or current grade                                          Name                                Birthday (MM/DD/YYYY)          Boy        Girl     Year starting kindergarten or current grade                                          Name                                Birthday (MM/DD/YYYY)          Boy        Girl     Year starting kindergarten or current grade

Membership

Category

$$

Explanation

General Membership

$35

Member has a child in kindergarten or younger. Members can participate in monthly meetings, social activities, playgroups and our online group.

Sustaining Membership

$25

Sustaining members youngest child is in first grade or older. They can still enjoy the monthly meetings, social activities and online group participation.

    Please select the membership you are interested in

Spring Market Donation Packages (optional)

All net proceeds from the Spring Market directly benefit University Park Elementary School. Donor benefits are as follows:

Less than $50

$50-$99: Bargain Shopper (Program recognition and 2 market tickets)

$100-$249: Window Shopper (Program recognition and 4 market tickets)
$250-$499: Frequent Flyer (Program recognition, 6 market tickets, 10 raffle tickets, 1 Future UP Panther T-Shirt)
$500+: Shop Till You Drop (Program recognition, 10 market tickets, 25 raffle tickets, 1 Future UP Panther T-Shirt, Free admission for two to the Couples Party, Free admission for three to the Children's Events)

Package Amount: $

T-Shirt Order & Misc

Don't forget your future UP Panther! ($16.24 per shirt)

Specify size and number of shirts below:

2T

3T
4T
Youth XS (4/5)

Amount for T-Shirt: $
          Additional Directory ($5 per directory. All memberships include 1 directory): $

Payment

          Pay by Credit Card: (All credit card transactions will be charged a $1.20 online transaction fee.)

Credit Card Number CC Expiration Date

Name as it appears on the card CID # (3 digit # on back of card

Card Type         Amount $

          Pay by Check:

          Please mail a check to: University Park Preschool Association, 7623 Bryn Mawr, Dallas, TX 75225

The UPPA acting on behalf of the UP PTA is exempt from Federal Income Tax under section 501 (c)(3) of the Internal Revenue Code. The tax identification number for University Park Elementary School is 1-75-08556737-4. Per IRS Publication 526, Charitable Contributions, goods and services received (market tickets, raffle tickets and Spring couple's party tickets) are not tax-deductible. Therefore, the amount you may deduct for tax purposes must exclude the value of those items. An email will be sent to donors with their tax deductible amount.



Questions? Send them to membership@uppre3.uppreschoolassociation.com

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FORM MUST BE SUBMITTED BY SEPTEMBER 15th TO BE INCLUDED IN THE MEMBERSHIP DIRECTORY

Category	$$	Explanation
General Membership	$35	Member has a child in kindergarten or younger. Members can participate in monthly meetings, social activities, playgroups and our online group.
Sustaining Membership	$25	Sustaining members youngest child is in first grade or older. They can still enjoy the monthly meetings, social activities and online group participation.