Membership Application

Please print and fill out

___ $35 New member*_____$35 Renewal

Name _______________________________________________________________

Address _________________________________City_____________Zip_________

Telephone Number______________________Fax Number__________________

Email Address________________________________________________________

License Number______________________________________________________

Birth date ____________________________________________________________

For a one- (1) year membership: Please enclose a check or money order for the amount indicated above (non-refundable), made payable
to The professionals Network Family Childcare Association. A $25.00 service fee will be charged for all returned checks.

Membership includes
*Monthly meetings
*Networking
*Informative Training and Workshops
*Licensing updates *Referral System *Newsletter
*And many more enriching experiences