Officers for the  school year (please insert year – example: 2010-2011)
Complete Name of PTA or PTSA or Council
School Address
City Zip Code
School Type (select one)
Location Name (Name of City or County)
Region     District
LUR# - Local Unit Resource Number Located on Membership Card 
  (Enter 8 numbers that begin with 0s - don't leave blank)
EIN (Employer Identification Number)
  (If EIN is unknown enter 00-0000000, don't leave blank)

PRINCIPAL (select one) Dr. Mr. Mrs. Miss Ms.
Name 
Email Address     Bulletin

LOCAL UNIT PRESIDENT (select one) Mr. Mrs. Miss Ms.
Name
Home Address
City Zip Code
Work Phone with Area Code [eg ddd-ddd-dddd]
Home Phone with Area Code [eg ddd-ddd-dddd]
Email Address     Bulletin

TREASURER (select one) Mr. Mrs. Miss Ms.
Name 
Home Address
City Zip Code
Work Phone with Area Code [eg ddd-ddd-dddd]
Home Phone with Area Code [eg ddd-ddd-dddd]
Email Address     Bulletin


OTHER POSITIONS

TITLE (select one) Mr. Mrs. Miss Ms.
Name
Home Address
City Zip Code
Work Phone Home Phone
Email Address Bulletin

TITLE (select one) Mr. Mrs. Miss Ms.
Name
Home Address
City Zip Code
Work Phone Home Phone
Email Address Bulletin

TITLE (select one) Mr. Mrs. Miss Ms.
Name
Home Address
City Zip Code
Work Phone Home Phone
Email Address Bulletin

TITLE (select one) Mr. Mrs. Miss Ms.
Name
Home Address
City Zip Code
Work Phone Home Phone
Email Address Bulletin

TITLE (select one) Mr. Mrs. Miss Ms.
Name
Home Address
City Zip Code
Work Phone Home Phone
Email Address Bulletin

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