Local Unit & Council Officers Contact Information & Bulletin Subscription Form Due June 15 of each year

PLEASE NOTE: You are recommend to use Firefox 3 or IE7 (or above) to submit this form. If all applicable fields are completed correctly, you will receive a confirmation email of receipt within a couple of minutes with the information you submitted. In addition, a web page will appear indicating a successful submission. If you do not see this successful submission page, then the form was not completed correctly and must complete the form's required fields correctly. Any questions or have not received your confirmation information in 5 days, please contact our state office at: 804 264-1234, email us.

The Code of Virginia governing nonprofits (http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+57-49) requires all local units and councils to have on file with the Virginia PTA their EIN number and the names and addresses of all PTA officers. To adhere to policy, each unit/council must submit the required information to the state office each year after elections.

IMPORTANT: Pursuant to the Code of Virginia, please complete and submit this form as soon as your officers are elected --even if officers are serving a second term. In the event that your PTA's election is held in the fall, you will need to resubmit the new officers' information at that time. Failure to complete this form by June 15 of each year may result in a disruption in services.

All information that you supply to us is considered to be the proprietary and confidential information of Virginia PTA and is not shared or sold to any outside party.

Board members listing email addresses will be automatically signed up for Virginia PTA's electronic newsletters, Virginia PTA VOICE, and Legislation ACTION ALERTS. They may unsubscribe at any time by following instructions published in every issue.

BULLETIN SUBSCRIPTIONS:

LOCAL UNITS - Each Local PTA/PTSA is entitled to 5 free subscriptions. Subscriptions for your principal, local unit president and treasurer are included in this number. Please select 2 additional recipients for a free subscription. If you would like to order additional subscriptions, please send payment in the amount of $10 made payable to Virginia PTA for each additional subscription.

COUNCILS - Each Council receives 4 subscriptions (one for the council president and 3 additional subscriptions).

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

OPTIONAL Download Form for Mailing Please mail, fax or Email to:
Virginia PTA/PTSA
1027 Wilmer Avenue
Richmond, VA 23227-2419
Fax: (804) 264-4014
Email: info@vapta.org

PLEASE SUBMIT FORM IMMEDIATELY UPON ELECTION OF OFFICERS
 
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