Center/Affiliate
Membership Application

Organization/Agency:

Contact Person:

Address:
City:
State:
Zip:
Phone:
Fax:

Email:
What is the number of children your childcare center is liscensed to care for?
Dues amount:
(Use scale below to calculate correct amount based on number of children you are licensed for)
Under 30 children
Between 30 and 50 children
Over 50 children
Affiliate member (non-voting)
   $25
$30
$35
$20		  

Is there a special area of childcare which interests you?

Childcare laws and regulations

Staff development and training

Childcare curriculum

Providing parental support

Other

What special talents and skills do you possess that will help further the mission of WVCCU?
Why do you want to become a member of WVCCU?

 


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