MSA Booster Club Membership Form

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Membership Application

Booster Club: "Proud to Serve Young Minds"

Mission Statement

The purpose of this organization shall be to Enhance, Support, Encourage, and aid all activities of the DHS Math and Science Academy.

Visit us online at: www.dullesmsabc.org

Student Last Name *

Student First Name *

Student Grade Level in school *

9th

10th

11th

12th

Parent 1 Name *

Parent 1 Cell phone # *

Parent 1 email *

Parent 2 Name

Parent 2 Cell phone #

Parent 2 email

Please indicate your contribution below. The payment could be made online (via PayPal or ChasePay) or with check (payable to DHSMSABC). You could present the check during our monthly meeting or send it by mail to: DHS MSA Booster Club, P.O. Box 16883, Sugar Land, TX 77496 Please include the student name in your payment memo.

$25 (Membership amount)

$50

$100

Other (please specify the amount when making payment )

Clear selection

If you as parent(s) want to be added to the WhatsApp Booster Club Group to receive club updates and activities, please indicate below *

Yes and for both parents

Yes and for parent 1 only

Yes and for parent 2 only

No I don't want to be added

After you submit the application, you will be able to make online payment with the provided PayPal link. Thanks!

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