Ohio Connection State Family Child Care Association

Ohio Connection

Membership Form

Name:___________________________________________________________

Address:________________________________________________________

County:_________________________Local Association:_________________

City:___________________________Ohio, Zip:_________________________

Phone: (     )_____________________E-mail Address____________________

I wish to join the Association as

( ) Provider   $30

( ) Local Association Members ($10) (If local association dues are current)

( ) Parent       $10

( ) Partners of Providers   $50 (Agencies, Local Associations)

Make check or money order payable to:  Ohio Connection; Mail application and dues to:

                                                Pat LaBauve

                                                2509 Lowell Ave.

                                                Lima, Ohio 45805

Membership Benefits