2016-2017 SECA Membership

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* Date:

Date / Time

Date

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* Please enter your Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* What is your SECA Membership number?

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* Are you licensed through the Ministry of Education?

Yes. (enter your license number)

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* Membership Type

Child Care Centre - $200.00
Any size centre, includes two memberships

Group Home - $200.00
More than 8 children, includes two memberships

Family Home - $125.00
8 children and less, includes one membership

Professional -$125.00
An individual working in a field related to early childhood

Corporate -$250.00
Supportive partners

Full Time Student - $50.00
Enrolled in ECE or child focused studies

Parent/Board Member - $50.00
Not working with children

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* Will you purchase additional memberships? ($50.00/additional membership)

Yes (please enter how many additional memberships)

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* If purchasing additional memberships, please include your staff's name and email address

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* Would you like to purchase a Canadian Child Care Federation (CCCF) membership for $25.00? This membership is optional. Purchasing through SECA is a $40.00 savings. You must have a SECA membership for the discount

Yes

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* Payment Method

E-transfer (Please contact the office to make arrangements)

Cheque

Credit Card (please enter name on the card, credit card number, expiration date and CVC/CVV number)
Credit card information is destroyed once processed