Membership Form
Thank you for your interest in joining AGATE of Port Washington! Please fill out the form below. When you click "submit," you will receive a link to pay the $25 annual membership fee* with a credit card via PayPal. You will also be invited to donate to our scholarship fund.

*Please note that the membership fee is waived for families that qualify for free or reduced lunch. Please contact co-presidents@agatepw.org with any questions.
Name *
Today's Date *
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Address *
Best phone number to reach you
Email address *
Please list each child you have in the school district, along with their school and grade. *
After you submit this form, you will receive a link to pay AGATE's annual $25 membership fee with a credit card via PayPal. We hope you will also contribute to the Toula J. Halperin Scholarship Fund! Please check the appropriate box below to indicate the amount you plan to pay via PayPal. *
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