Membership and Donation Form

Membership and Donation Form

Langley High School PTSA 2022 - 2023
Your membership enables the PTSA to enrich the Langley High School student experience by funding improvements to our school, including curriculum support, continuing faculty education, student/parent programs & speakers, and ever-changing technology needs.
Your Name *

First Name Last Name
E-mail *

Confirmation Email
Membership Type *

Parent ($25) Student ($5) Teacher/Staff ($5) Donation Only
Student's Name *

First Name Last Name
Student's Grade *
Homeroom *
Department *
Other Department *
Your tax deductible donation supports cutting-edge technology, innovative teaching development, school e-newsletter, and more. This is the primary PTSA fundraiser for the year.

Annual Donation: $100 suggested per student

Premier Donation Levels

Saxon: $1,000+

Gold: $500 - $999

Green: $250 - $499
Number of Students *
Attending LHS
Students *
A donation of $100 per student is suggested, but any amount that you are comfortable contributing will benefit our students. Thank you!
Donation *
tax deductible as a 501(c)3 non-profit
Enter Amount
Your Premier Donation Level is GREEN
Your Premier Donation Level is GOLD
Your Premier Donation Level is SAXON
Name as should be published on Donor List
Matching Company Donations
Company Name (PTSA will help with paperwork)
Dues
Donate
Total
Total includes $25 membership fee plus optional donation amount
Payment Method *

Pay Online (PayPal, Credit/Debit Card)
You will be directed to our online payment processing site after you click Submit.
Online Total
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USD PTSA Dues and Donation

For PTSA Administration
Name of Member

First Name Last Name
Pledge
Check or Cash *

Check Cash
Check Number *
Amount Received *
Does Not Match Total on Form
Date Received

Month Day Year
Send Membership Thank You Email

Yes No
Send Donation Email

Yes No
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