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**PLEASE RETAIN A COPY OF THIS REPORT FOR YOUR RECORDS.PTA Membership Roster and DUES REPORTMail with payment to: Texas PTA 408 W. 11th St. Austin, TX 78701
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DatePTA ID #
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PTA NamePerson Submitting Report
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School DistrictEmail Address
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PTA PresidentTelephone Number
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NUMBER OF MEMBERS AND DUES PAYMENT
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# _______________Regular Members X $4.50 each =$_______________
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# _______________Texas Life Members X $2.25 each=$_______________
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# _______________TOTAL $_______________
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Check Number:_______________
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PTAs should only enter members below who have NOT been previously reported to Texas PTA during the current membership year.
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*Member TYPES: R=Regular T=Teacher S=Staff S=Student G=Grandparent C=Community. Indicate Honorary TxPTA Life Members
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First NameLast NameEmailPhone number or AddressMember Type*Honorary TX PTA Life Member?
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