Membership

Membership Application 2008-2009

Adams County Association of Family Childcare

Membership Application 2008-2009

ACAFCC Membership Benefits Include:

Free referral service

A minimum of 15 clock hours yearly of training

Accidental death and dismemberment insurance

Bi-Monthly newsletter

Network of providers to help and support you in your professions

Rangeview library outreach program

MEMBERSHIP SUBSCRIPTION FEES ARE RENEWABLE JULY 1ST OF EACH YEAR

Please fill in the following information

Name:_____________________________________________ Date of Birth: Month______ Day______

Address:_________________________________ City______________________ Zip Code___________

License number _______________ *Year Licensed ________ # of Years Licensed _______

*(This information is used for years of service recognition 5, 10, 15 years etc)

E-mail Address __________________________________________ Ph. # ______________________

Text Box: FAILURE TO SUBMIT A COMPLETE REGISTRATION FORM and A CURRENT COPY OF YOUR CHILDCARE LICENSE on file AND MEMBERSHIP FEES WILL RESULT IN REMOVAL FROM THE REFERRAL LINE ON JULY 1ST.

We ask that all members voluntarily provide a non-returnable copy of their childcare license within 30 days of their childcare license renewal date to the membership coordinator in order to receive the benefit of referrals. If ACAFCC already has a current copy of your childcare license at the time you apply for renewal, you do not need to submit one with your membership application. We request that upon receipt of your renewed license you submit a copy of the renewed license to the membership coordinator. If a current copy of your licence is not on file with the membership coordinator, the benefit of referrals will be denied till a current copy is on file. All Providers that are new members must submit a copy of their licence at the time the application is sent in.

Please return this application, a copy of your license (if applicable) and your check or money order for $30.00 made payable to ACAFCC, and mail to: ACAFCC Membership, P.O. Box 1325, Eastlake, CO 80614 (Please put your license number on the check or money order.) If you have any questions, please contact the (Membership Coordinator).

I am interested in becoming involved in one or more of the following committees:

(Check all you are interested in)

( ) By-Laws ( ) Grievance ( ) Nominating

( ) Membership ( ) Newsletter ( ) Fund Raising

( ) Parties ( ) Mentor ( ) Publicity

Enclosed is a check or money order for:

License renewal date______________________________ACAFCC Membership Renewal ($30) _____

License renewal date_____________________________________ACAFCC New Member ($30) _____

License renewal date___________BOTH ACAFCC Membership and CAFCC Membership ($60) _____

(You may write a check payable to ACAFCC for $60, this includes your $30 ACAFCC fee and $30 CAFCC Fee.)

Enclosed is a non-returnable copy of my current childcare license if applicable