1) Print this form on your printer
2) Complete the application below
3) Mail to address below with postmark not later than May 15th

NAME OF STUDENT:________________________________________ DATE:________________

AGE:__________ SEX:___________

ADDRESS:_____________________________________________

CITY ___________________________ STATE _________ ZIP _____________

HOME PHONE #:______________________________

NAME OF SCHOOL YOU CURRENTLY ATTEND:________________________________

CURRENT GRADE LEVEL:_________________________

FAVORITE SUBJECT:______________________________

PARENT(S) / GUARDIAN(S) NAME:_________________________________

PHONE NUMBER:_________________________, FAX # (IF APPLICABLE):________________

EMERGENCY CONTACT NAME:_________________________________

PHONE #:_______________________________

FOR PARENT(S), GUARDIAN(S), FAMILY:

   ARE YOU A TAI MEMBER?    YES_______ NO_______
   IF NO, WOULD YOU LIKE TO JOIN?    YES_______ NO_______

   IF YOU WOULD LIKE TO JOIN, INFORMATION AND TAI MEMBERSHIP APPLICATION FORMS ARE AVAILABLE ONLINE UNDER "NEWS" AT WWW.TAIMEMPHIS.ORG

MY EMAIL ADDRESS IS:_______________________________

YOUR NAME:___________________________________________

ADDRESS:_____________________________________________

CITY ___________________________ STATE _________ ZIP _____________

Mail your completed application to:

Memphis Chapter -TAI
Summer ACE Academy
P.O. Box 381886
Germantown, TN 38183-1886