Please check the appropriate category:

Individual/Family Child Care Provider: $45.00
Group Family Child Care Provider: $55 - for provider and 1 assistant, and $12 for each additional staff. Please provide a separate sheet with names of all staff members included in membership.
Center-Based Child Care Provider: $60 for 1-5 Staff ($12 for each additional staff member, not to exceed $400) Please provide a separate sheet with names of all staff members included in membership.

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Additional Staff Members

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Organization:

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First Name:

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Cardholder Name

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Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

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