LogoUSA Child Care Membership Application and Invoice

USA Child Care is developing a membership profile to be shared with funders and policy makers at federal, state and local levels. Please print this form, then provide all requested information so that we may better serve you.


Name of Agency/Center:

Primary Contact:                                                                   Title:

Street Address:

City:                                                                   State:                                     Zip:

Phone: ()Fax: ()

E-mail:
(Providing your email will automatically enroll you on the member-only listserv.)

Number of children served:

Number of children who receive government child care subsidies:

Is your program accredited?       Yes       No

Accredited by:

Your Name:                                                                         Title:

Please remit payment based on your membership category:

   Affiliate Membership   $25/affiliate ($500 minimum, see details here)

  Agency Membership   $65

  Family Child Care Provider Association Membership   $65

  Individual Family Care Child Provider Membership   $50

  Associate Membership   $50

Sustaining member:

   Advocate   $100 - $499

  Bronze   $500 - $999

  Silver   $1,000 - $2,499

  Gold   $2,500 - $4,999

  Benefactor   $5,000 +


Please attach your check, made payable to USA Child Care, and mail to:
Dolores Meade
USA Child Care Membership
c/o  Options
100 N. Citrus  #300
W. Covina, CA  91791

Fax: 626-967-8638
dmeade@optionscc.org