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Membership Application

ONLY USE THIS FORM IF YOU ARE GOING TO MAKE AN ONLINE PAYMENT.

Once you complete the form, you’ll be returned to this page. DO NOT SUBMIT THE FORM MORE THAN ONCE. Once you submit the form, please go to the payment page to make an online payment.

* Required fields
Name *
E-mail Address *
Confirm Email Address *
Mailing Address *
Phone Number
I am a... *	new member renewing member
Type of Membership *	student / $10 nanny / $15 nanny employer / $25 school or training program / $25 other / $25
If you checked "other" above, please describe.
Students, please list the school you attend and your area of study.
Schools / Training Programs, please list name of your program.
Newsletter Version *	I'd like the email version of the newsletter included in my membership. I'd like the print version of the newsletter. I understand it requires an additional fee of $12.
Total Amount Due *
Highest Level of Education Completed	high school some college Associate’s degree Bachelor’s degree Master’s degree
If you're a member of your local nanny support group, please list the group's name.
	I DO NOT want to be listed in the NANC directory
	include my full street address in directory listing
	include my city and state only in directory listing
	include my phone number in directory listing
	include my email address in directory listing
	include my support group affiliation in my directory listing
How did you hear about NANC?

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