CAEYC Membership Form

Please print out this application form, then fill it out, and
mail it (along with check payable to "NAEYC") to:

NAEYC Membership
P.O. Box 97156
Washington, DC  20090-7156

Or you may join online, using a credit card, 
by going to NAEYC's Web Site (www.naeyc.org).

(Please print or type)

Name __________________________________________________________________
                   (First Name, Middle Name, Last Name)

Mailing Address __________________________________________________________

                          __________________________________________________________

City ______________________________________ State _____    Zip _______________

Affiliate Group Number         82    

Please check:        Comprehensive .............................. $85   ___
                             Affiliate .......................................... $50   ___
                             Student .......................................... $40   ___

Date mailed ____________________________

Renewal ______   (ID Number) ________________

New _______

Home phone  (____)_________________   Work phone  (____)_________________

E-mail ______________________________________________________________

Employment _______________________________________________________

Signature of College official to verify full-time student status:

______________________________________________________
                                                    Name

______________________________________________________
                                                    College

Questions or problems regarding this web site should be directed to CAEYC@ColoradoAEYC.org.