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.

“All-In” Membership

$525

Participate in everything the UPPA has to offer this year, including: membership, Shop Till You Drop benefits (see below for details), and free admission to the couples parties.

    Please select the membership you are interested in

Spring Market Donation (optional)

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

$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 and 25 market raffle tickets)

$500+: Shop Till You Drop (Program recognition, 10 market tickets and 50 market raffle tickets)

Donation Amount: $

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 kbevans@balfourbeattyus.com

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FORM MUST BE SUBMITTED BY SEPTEMBER 22, 2008 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.
“All-In” Membership	$525	Participate in everything the UPPA has to offer this year, including: membership, Shop Till You Drop benefits (see below for details), and free admission to the couples parties.