GAPTA Membership Award Application Form

Purpose:

Use this form to inform the state PTA office that your local unit PTA has achieved Target Membership

Instructions:

This form must be submitted by the last business day of the month listed to qualify for the respective award.
Dues MUST be paid by the same date. Submit Dues Remittance Form and check to the state office postmarked by the respective dates.
Make checks payable to Georgia PTA. Mail to Georgia PTA, 114 Baker St, NE, Atlanta, GA 30308-3366. (A $30.00 service fee will be applied for returned checks).
Please direct any questions to membership@georgiapta.org

Submitter Full Name*

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Submitter Email Address*

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Date*

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District*

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Local Unit ID #*

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Council*

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School Enrollment plus Certified Staff #*

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PTA Name*

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Contact Person*

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PTA Position*

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Address*

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City*

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State*

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ZIP Code*

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Cell Phone*

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Home Phone

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Email Address*

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Check Award Level

The Visionary Pin and Certificate: 400 members to Georgia PTA by last business day of August.

The Pacesetter's Certificate: 300 members to Georgia PTA by last business day of August.

The Early Bird Certificate: 200 members by the last business day of September.

The Platinum Membership Award: Target Membership achieved and dues sent to the state PTA office no later than the last business day in September.

The Gold Membership Certificate: Target Membership achieved and dues sent to the state PTA office no later than the last business day in October.

The Silver Membership Certificate: Target Membership achieved and dues sent to the state PTA office no later than the last business day in November.

The Bronze Membership Certificate: Target Membership achieved and dues sent to the state PTA office no later than the last business day in February.

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(Please note: In order to qualify for an award level, dues and this form must be postmarked by the last business day of the month indicated for the respective award. The state PTA office may verify Student enrollment.)

Total of PTA members enrolled and submitted to state office*

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Student enrollment at the end of the first full week of school*

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Number of certified teachers at the end of the first full week of school*

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Total of lines 2 and 3 (# of members required for above rewards)*

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(line 1 must equal or exceed line 4)

Signature of President or Membership Chairperson (Type name here to serve as signature)*

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