Father's Name
Address, City, State, Zip
Father's Work Phone

Mother's Name
Address, City, State, Zip
Mother's Work Phone

Home Phone

Email

Student's Name

Classification Freshman Sophomore Junior Senior Graduate student

Major

Please check the boxes that apply:
Yes, I/We want to participate in the Parents Association and my/our $50 membership dues is in the mail.

Yes, I/We would like to be involved in General Membership.

Yes, I/We would like to be involved in Special Events.

Yes, I/We would like to be involved in Volunteer Opportunities

Maybe, Please send me additional information as it becomes available.

I give my permission to release my address and phone
number for publication in the Tarleton Parents' Directory.

This form is in adherence with the Tarleton Privacy Policy, as specified on the University Web Guidelines.