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MIPA Membership Registration
Please provide the following information:
Contact information:
MIPA will keep your email private and will use it for internal communication only. We do not share out list with anyone.
Parent 1
Firstname:
Lastname:
Home phone:
Work phone:
Cell phone:
Email:
Address:
City:
State:
Zipcode:
Parent 2
Firstname:
Lastname:
Home phone:
Work phone:
Cell phone:
Email:
Children Information:
Child 1 name:
Birthday:
Boy
Girl
Child 2 name:
Birthday:
Boy
Girl
Child 3 name:
Birthday:
Boy
Girl
Child 4 name:
Birthday:
Boy
Girl
Child 5 name:
Birthday:
Boy
Girl
Volunteer opportunities:
What events would you like to volunteer for? (shifts are 2-3 hours)
All major events
Halloween
Toy Swap
Preschool Fair
Circus
Host social or parent ed lecture
Host general meeting
Contact me about:
I am interested in being contacted about:
Playgroups
Mom's night out
Dad's night out
Dinner group
Card(Bunko) group
Book group
Parent Ed Lectures
Music Events
Member directory selection:
MIPA publishes a member directory that includes member's contact information about themselves and their children. This helps connect parents for play dates and other activities. The MIPA directory is available only to MIPA members: (check box for the following)
Please do not include my children’s names/ages in the MIPA directory.
Please do not include my personal information in the MIPA directory.
Payment Type
Paypal selection
I would prefer to pay by check. Please send your check to: MIPA Membership, P.O. Box 464, Mercer Island 98040.
Terms and Conditions:
1. New member -- 1 year $40
2. New member -- 3 year $100
3. MIPA membership runs from July 1-June 30 (per the Washington PTA).
* By clicking this button, you agree to abide by the terms and conditions provided by MIPA.
