OCCCA Membership Form

The Orange County Child Care Association would like to invite you to join (or rejoin) our professional organization for licensed Family Child Care Providers. General membership is for licensed family child care providers providing services in Orange County. With your paid membership you will receive, many benefits including, a bi-monthly newsletter, general meetings, workshops and child care referrals. Please take this opportunity to become "Part of the Solution" as we all work together to deliver quality child care.

GENERAL MEMBERSHIP APPLICATION

New Member Membership Expired Renewing Member Returning Member Small FCC Large FCC

Name

First Name Last Name

Email

example@example.com

License Number

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

If you would like your daycare website or Facebook daycare page attached to your name on the OCCCA website, please list it below.

Website/FB page

Hours you work

What language you speak

What programs you work with. ( dept. of Ed, CHS, CalWorks, Capslo)

Please enclose all of the following items

Photocopy of your DSS License is need it. ( not required for renewing members with active license on file with OCCCA ) $45.00 payment for one year's membership

Please allow 4 to 6 weeks for membership processing. There will be a $30.00 charge on all returned paymnet. There is a $5.00 replacement fee for lost membership cards. If you have any questions about OCCCA membership or the application, please contact

Michelle Spoor, Membership Chairperson at (714) 222-4922 for membership information or e-mail us at contacus@orangecountychildcareassociation.org

Membership Use Only: Member's Expiration Stamp:________________________

Interoffice: Forward to Membership Chairperson ________________________

My Products

USD MEMBERSHIP

Pay with PayPal

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

ORANGE COUNTY CHILD CARE ASSOCIATION