Family Child Care Providers, Inc.
P. O. Box 277494 v Sacramento, CA 95827
v email@example.com www.fccpinc.org
2009 Membership Application
New Phone 916-504-9859
City ___________________________________ State _________________ Zip Code _____________
Are you a New Member or
Renewing Member? New ________ Renewing ________
ALL NEW MEMBERS must submit a new copy of their license.
2. Would you like to make a contribution to
the Scholarship Fund? If so, please list the amount and make out a separate check for that amount. $________
3. Do you want your name, city, zip code, phone number &
license number listed on the FCCP, Inc Web Site Referral Page?
Yes ________ No ________ You must
sign here that you understand you Name, Telephone Number, Zip Code and License Number will be posted on the website.____________________________________
4. You understand and acknowledge the terms
of Article II: OBJECTIVE AND PURPOSE of FCCP, Inc. as stated
in the Bylaws:
Section 2.1 FCCP, Inc. is incorporated and shall be a non-profit organization
among all licensed family child care providers.
Section 2.2 FCCP, Inc. shall promote quality child care services for the
Section 2.3 FCCP, Inc. shall provide educational assistance on issues pertinent
to quality family child
Section 2.4 FCCP, Inc. shall establish and encourage a professional working
relationship between family
child care providers, parents, the community and government entities.
Section 2.5 FCCP, Inc. shall participate with policy-making agencies (city,
state and federal) to work for
changes, modifications and implementation of standards necessary to provide quality home
child care for all children.
Yes ________ No ________
5. Please mail this signed application,
with a copy of your license, & check or money order made payable
Child Care Providers, Inc.
P. O. Box 277494 s Sacramento,
CA 95827 916-504-9859
Membership Dues: $30.00 Dues are good from January 01, 2010 through December 31,
2010 (Please allow 2 – 3 weeks for processing)
Amount Enclosed $____________________
Member’s Signature: _____________________________________________
This application WILL NOT be processed without your signature
For Office Use Only
Number_______________ Amount_______________ Welcome Packet Sent________________________________
Book ______________ Number _________________ Web Site ___________________________________________
Membership Card/Receipt Sent________________________ Zip Code List ________________________________________
List updated_____________________________ Newsletter List