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PTSA Membership and Donation Form (Credit Card Processing)

Dear Parents,

Thank you for using our safe online form for your registration and direct donation. UCHS PTSA is using PayPal, a leader payment provider that allows our PTSA to securely process Credit Card payments.

Name *

Address Line 1 *

Address Line 2

City *

State *

Zip *

Email *

First PTSA Member Name *
 Student Parent Teacher/Staff Community Member/Business

Second PTSA Member Name
 Student Parent Teacher/Staff Community Member/Business

Third PTSA Member Name
 Student Parent Teacher/Staff Community Member/Business

Fourth PTSA Member Name
 Student Parent Teacher/Staff Community Member/Business

 Yes, my employer has a matching donation program

 Yes, I need a PTSA membership card (if not checked you will not receive a card)

 Yes, I wish to remain anonymous. Please do not post my name on the UCHS PTSA website as a donor (if not checked your name will be listed on our donor page if you contribute above the membership fee of $13 per person)

Student Name(s) (this information is necessary in order to send you a PTSA membership card)

Student Grade Level(s)

Type this text below: captcha

* Required Fields

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University City High School