Center Membership Application (34 or More Capacity) Registration for Centers with 34 or more licensed capacity Not a Member of MD Excels 2019 Annual Center Membership Application & Profile- All Staff are MSCCA Members If you operate more than one Child Care Center, please reproduce this form, complete a membership application and center profile for each Center, and mail them as a group. Please include all centers under common ownership. A copy of your child care license must be submitted with your application. MSCCA is a 501(c)(3) Charitable Organization, EIN:52-1398476 If you are a renewal and require an invoice, please contact email@example.com. Why become a member? TOTAL NUMBER OF ALL CENTERS IN YOUR ORGANIZATIONPlease enter a number from 1 to 100.MEMBERSHIP STATUS*New MemberRenewalEMPLOYEES*Please enter a number from 1 to 2000.Total number of employees at this centerMD LICENSE NUMBER*Please enter your Maryland State License Number for your centerCENTER FUNCTIONS ASFor ProfitNot For ProfitACCEPTS SCHOLARSHIPS* Yes No Formerly known as Subsidy Vouchers.LICENSED FOR Select All Infant/Toddlers Two's Three's Four's School Age Infant/Toddlers License CapacityTwo's License CapacityThree's License CapacityFour's License CapacitySchool Age License CapacityCENTER/PROGRAM CONTACT NAME First Last TITLENAME OF CENTER/PROGRAM:*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*COUNTY*Email CENTER WEBSITE OWNER'S NAME First Last OWNER'S EMAIL Enter Email Confirm Email MEMBERSHIP DUES FOR CALENDAR YEAR 2019Center Membership and benefits includes all staff employed in your program as members. Copy your center/program membership certificate for ALL staff and use for Professional Activity Units, discounts for training and more. Membership Dues Price: $3.90 OCC Licensed Capacity of This Center*Optional: Contribute to Government Relations Advocacy Choose your donation amount.Optional: MSCCA Passion for Excellence Grant/Scholarship Tax Deductible donation. MSCCA Members only are eligible to receive grant. All donations go directly back to our MSCCA programs/providers. Choose your donation amount.Optional: National Child Care Association Annual Dues = $22.00 Total Amount Due $0.00 Follow us on Facebook!