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Child Care Providers Coalition Of Kansas,Inc.
Individual Membership
(One year from the date you join)
Name_________________________________________
Business Name________________________________
Business Address____________________________
City_____________________State_________ ZIP_________
Home Phone(____)____________ E-Mail: ______________________
Please Check your Membership Category:
_________ Full Membership - $20.00
_________ Supportive Membership - $20.00
_________ NAFCC Membership - $30.00
** NOTE If this is a renewal, your expiration date shows on your newsletter label. Please renew before the date shown to assure continued receipt of your membership services.
How long have you been a provider?_____
How long have you been a CCPC member?_____
How did you hear about CCPC?_______
Do you have your CDA?____ Accreditation?___
AA, BA, Early Childhood ED?____
Are you a Second Helping Graduate?____
Would you like to help CCPC?____
Please make your check or MO payable to CCPC.
Return check fee: $10.00
Send to CCPC, P.O. Box 121, Emporia, KS 66801.
Please allow 4 weeks for processing.
For questions contact:
Jayme McKinney, Membership Secretary: (785) 266-8631, or jmecorner@yahoo.com
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