MTHEA Family Registration Form
Membership Dues: $35 (date payment for July 1, 2010)
Make checks payable to MTHEA
Co-op/Tutorial Name: ___________________________________
Mother’s
Name __________________ Father’s Name____________________ Last
Name_____________________________
Address: __________________________________________________________________________________________________
City: ____________________________________________________________________________ Zip:_____________
Home Phone: _________________________ Cell Phone:
___________________________________________
Umbrella
School: _________________________________________________________
Student’s Name Grade Age
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
E-mail: _______________________ Would you like to join email group? Chat c Announcements c
Will you have a graduating senior in 2011? Yes c No c
Number of years your family has homeschooled? _______
For Office Use Only
Check # ______ Cash _______
New Member: Returning Member:
Packet sent_____________ Membership card sent ___________