Center Membership Application (33 or Less Capacity) Registration for Centers with 33 or less licensed capacity. Not a Member of MD EXCELS. 2020 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 need are a renewal and you require an invoice, please email 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 ProfitACCEPT SCHOLARSHIPS (Formerly known as Subsidy Vouchers) Yes ACCEPT SCHOLARSHIPS (Formerly known as Subsidy Vouchers)*YesNoLICENSED FOR Select All Infant/Toddlers Two's Three's Four's School Age Infant/Toddlers Licensed CapacityTwo's Licensed CapacityThree's Licensed CapacityFour's Licensed CapacitySchool Age Licensed CapacityOCC License Capacity*CENTER/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 COUNTY*Phone*Email CENTER WEBSITE OWNER'S NAME First Last OWNER'S EMAIL Enter Email Confirm Email MEMBERSHIP DUES FOR CALENDAR YEAR 2020Center 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: $105.00 Donation to Government Relations -Advocacy for Members Fund MSCCA is respectfully requesting an additional donation of $50.00 for programs of 50 or less children; or an additional donation of $85.00 for programs with 51 or more children, to fund the Professional Government Relations Lobbyists for the 2020 Legislative Session (Annual Fee for Compass Government Relations is $38,450.00).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!