Parent Pack Forms 2017-2018 WM PTSA Membership, Supplies and Donations Pay by credit card via PayPal as a guest for a more secure payment. You may also pay by check. If paying by check, instructions appear at the end of this form. Thank you! 1 Parent Information2 School Supplies and Field Trips3 Birthday Books4 PTSA Membership5 ASK Campaign6 Totals & Payment Parent InformationThis information is for PTSA Treasurer and accounting purposes only. Family contact information for the directory is being collected separately. Name of parent making payment* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone number*Email address* Parental Permission*Please let the PTSA know if we have your permission to post pictures of your child/ren and/or their artwork on our website or other social media (e.g., Facebook).No, thank you. Please do not post any pictures of my child/ren.Yes, I give my permission to post pictures of my child/ren and/or their artwork.*required School supplies - for EACH studentThe PTSA buys schools supplies in bulk. The funds also cover field trips and classroom activities. Financial aid is available for those unable to pay. This is tax-deductible. School Supplies/Field TripsEach child must be included for school supplies. (e.g. If you have 2 children, please chose a quantity of 2.) Price: $90.00 Quantity: Subtotal for School Supplies - Tax deductible Birthday BooksDuring the month of your child’s birthday, the librarian will select and purchase a book from the library’s wish list on your child’s behalf. When the book arrives, a decorative bookplate will be placed inside the book stating that it was donated in your child’s honor and then presented to your child during his/her class library time. Your child can then check out the book and be the first to enjoy it before it is returned to the library shelf for others to enjoy for years to come. In addition, your child will receive a keepsake bookmark as a special birthday present. Birthday book donations are tax deductible. Yes, I wish to purchase a birthday book.No, I do not wish to purchase a birthday book.Student 1 Name First Last Student 1 GradeKindergarten12345Student 1 Teacher NameStudent 1 BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Birthday Book Student 1 Price: $20.00 Student 2 Name First Last Student 2 GradeKindergarten12345Student 2 Teacher NameStudent 2 BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Birthday Book Student 2 Price: $20.00 Student 3 Name First Last Student 3 GradeKindergarten12345Student 3 Teacher NameStudent 3 BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Birthday Book Student 3 Price: $20.00 Student 4 Name First Last Student 4 GradeKindergarten12345Student 4 Teacher NameStudent 4 BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Birthday Book Student 4 Price: $20.00 Your Total Donation For Birthday Books - Tax Deductible Annual PTSA Membership - Tax DeductibleWe strive for 100% parent participation at West Mercer! A portion of your membership fee goes toward the Washington State PTSA Membership Service Fee and a remaining portion goes to cover the expenses of producing our West Mercer School Directory, which is delivered to your child via back pack mail. This membership is good for the school year. Don't forget your membership also provides you with discounts at the establishments listed here: Washington State PTSA Membership BenefitsAnnual WA State PTSA Membership for West Mercer (Includes a West Mercer Directory)Family Membership ($40) Covers membership for two adults.Individual Membership ($25)Teachers ($15)I do not wish to donateI already donatedSecond Adult Name for Family Membership First Last Extra Copy Of Directory Price: $10.00 Quantity: You may only order an extra copy of the directory if you are a WA State PTSA Member. This cost is NOT tax-deductible.PTSA Scholarship FundIn order to help us achieve 100% PTSA membership goal, the PTSA is creating a scholarship fund. We want every voice to be heard regardless of financial status. Please let us know if you would like a portion of your membership fee to go towards the scholarship by choosing the "Yes" box below. There is no added cost to you for doing so. Yes, I would like $1 of my membership fee to go to the scholarship fund. West Mercer PTSA ASK Campaign -- Your Dollars Matter!Your donations make a difference at West Mercer. The extra staff and enrichment programs funded by the PTSA are based on a $275 donation per student, and we encourage higher giving levels to provide greater learning support for our children. See a description of these levels and a list of the programs funded by this campaign. All Ask donations are tax deductible.Please choose a level belowGold Price: $450.00 Quantity: Silver Price: $350.00 Quantity: BronzeThe Bronze level covers the minimum donation required per student to cover learning support, assemblies, literacy support, etc. For more information click on Fundraising. Price: $275.00 Quantity: My Contribution to the West Mercer PTSA Define your own level of donation to the West Mercer PTSA. Contributions in any amount are helpful.ASK Contribution Total (Tax Deductible) Corporate Match Program*Yes, my company has a gift matching program.Not sure. I would like to investigate.No, my company doesn't have a matching program.Did you know that many local companies have programs through which they will “match” the charitable contributions made by their employees? WMPTSA raises a significant portion of our funds through Corporate Match. Check with your company’s Human Resource office to see if they offer gift matching. Company Name & Employee*Please include the name of your company and the employee name to help us apply any incoming donations. Some of the many local companies who participate: Adobe, Alaska Airlines, Amgen, Apple, Bank of America, Bill & Melinda Gates Foundation, Boeing, Costco, Expedia, Google, IBM, Key Bank, Merrill Lynch, Microsoft, Puget Sound Energy, Real Networks, Starbucks,Thrivent, Verizon, Wells Fargo, Yahoo. Click on your company and you will be directed to your employee benefits website where you can submit your request and not have to worry about it later. Is your company not listed above? No problem! Add your company name and employee name in the spaces provided. Almost Done...Last Step!An itemized list of your donation will be emailed to you once you complete this payment page. For further ways to get involved, please go to the volunteer page. To find out how exactly your WA PTSA Membership benefits you, please go to the WA State PTA website. Don't forget to like us on Facebook! Our GratitudeThe PTSA would like to recognize all those who have contributed to the funds that will help make the 2017-2018 school year a success. Please let us know how you would like your name to be displayed by choosing an option below: Please use the name as entered on first page.I'd rather remain anonymous.Total of Non-Tax Deductible PaymentsExtra DirectoriesTax Deductible Donation TotalSupplies/Field Trips + Birthday Books + PTSA Membership + Ask DonationsTotal of Donations and Payments $0.00 Payment Options*PayPal (or Credit Card via PayPal)Personal CheckPTSA Treasurer Use OnlyCheck NumberPlease input CHECK NUMBER for the Treasurers to reconcile your check to your order.ReconciliationCheck ReceivedDiscrepancy NotedThank you for your contributions!