Membership Application

ADCAN Membership Application

Name: _____________________________________________

Address: ___________________________________________

City: __________________State: ________________Zip:_______

Phone:_______________ e-mail____________________________

Birth date:____________________ Hometown & State: _________________

Date joined:______________________

new member _____previous member____

How long in DC Area: ______________________

How did you hear about ADCAN?___________________________

Committees:

Please check if you are interested.

newsletter____ fundraising_____ education____

social____ membership____ historian_____

refreshments____ publicity_____ volunteer_____

holiday party_____ all-area nanny picnic____

Please complete this form and send a check or money order payable to ADCAN for your membership dues.

Nanny- $35.00

Newsletter-$15.00

Associate-$35.00

Spousal-$15.00

Agency- Memberships are at different levels of $75 and $125. Please contact: ADCANLiaison@aol.com for further information.

If you would like to pay be credit card please visit our Pay your ADCAN fees online section.

ADCAN

P O Box 5502

Washington, DC 20016

If you have any questions please call or e-mail us!1-866-841-9139 ext 2176