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 _______________

E-mail Address ___________________________________________________________

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

Affiliate Group Number         82    

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

Please choose the publication package below that best meets your professional needs:

□ Subscription to Young Children
□ Subscription to Teaching Young Children
□ Subscription to both - additional fee of $19.00

Renewal ______   (ID Number) ________________  New _______

Employment ___________________________________________

Name of College to verify student status:

______________________________________________________
                                                    College

Date mailed ____________________________

Indicate your payment option:

____Check/Money Order

____Visa       

____Master Card

Card # ________________________________________  Expiration Date_____________

Cardholder's Name ________________________________________________________

Billing Address ___________________________________________________________

                        ___________________________________________________________

Signature ________________________________________________________________

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