School Age Application (33 or Less Capacity) Registration for School Age Programs with 33 or less 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 need are a renewal and you require an invoice, please email firstname.lastname@example.org Why become a member? TOTAL NUMBER OF ALL PROGRAMS IN YOUR ORGANIZATION:Please 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 program.MD LICENSE NUMBER*Please enter your Maryland State License Number for your centerCENTER FUNCTIONS ASFor ProfitNot For ProfitACCEPT SCHOLARSHIPS* Yes No Formerly known as Subsidy Vouchers.OCC License Capacity*PROGRAM CONTACT NAME First Last TITLENAME OF 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* PROGRAM WEBSITE OWNER'S NAME First Last OWNER'S EMAIL Enter Email Confirm Email MEMBERSHIP DUES FOR CALENDAR YEAR 2019MSCCA Center 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. Programs with licensed capacity under 33 children have a MINIMUM dues requirement of $55.00 MSCCA has a MAXIMUM dues cap not to exceed $1250.00 should the same owner have more than 15 pograms.Membership Dues Price: $55.00 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!