Membership Application

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School-Age Child Care: Membership Application

TennSACA Membership Application.
Mail with check to:
TennSACA Membership
PO Box 291692
Nashville, TN 37229-1692

Please print all information; please list EVERY individual and their information--especially email addresses.

Name of Agency:_________________________________
Name of person applying:________________________
Phone number: ( )____________________
Email:___________________ Fax:__________________
Agency Address:_________________________________
City:___________________________Zip:____________

Please circle type of organization:
Nonprofit Center
Public School
Youth Service Organzation (YMCA, YWCA,....)
For Profit Center
Religious Center
Other:_________________________________________

___Do not publish this information in the NAA member directory.
___We may occasionally provide our members' names & addresses to outside organizations we deem beneficial to members. Please check this box if you would like to keep this information private.

Name (s) of designated people for membership:
1._______________________________________
Job Title:________________Email:________________
2._________________________________________
Job Title:________________Email:________________
3.____________________________________________
Job Title:________________Email:________________
4.____________________________________________
Job Title:________________Email:________________
5.______________________________________________
Job Title:________________Email:________________
6.______________________________________________
Job Title:________________Email:________________
7.______________________________________________
Job Title:________________Email:________________
8.______________________________________________
Job Title:________________Email:________________

Circle the type of membership:

Individual $40.00 (TennSACA & NAA)

AGENCY MEMBERSHIPS: All individuals MUST be named. Every individual is a member of TennSACA & NAA (National Afterschool Association).

Level 1: ($135.00)1-5 People
Level 2: ($280.00)6-10 People
Level 3: ($420.00)11-15 People
Level 4: ($560.00)16-20 People
Level 5: ($700.00)21-25 People
Level 6: ($840.00)26-30 People
Level 7: ($980.00)31-35 People
Level 8: ($1,120.00)36-40 People

TennSACA