Membership Application Online Membership Application Personal DetailsName* First Last Current Month*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberAre you a NSCCA Member?*NoYesNSCCA Membership #*Membership must be current.Name of Centre where you are employed/studying*Email* Home Phone*Work PhoneHome Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Do you want your information shared with Scholar's Choice to receive a $10 store discount?*YesNoBy checking this box, I agree to become a member and support mission of the Nova Scotia Child Care Association* Yes, I agree Membership Status & FeesNew Membership Status & Fees*New Member - $55Student currently enrolled in an approved ECE program - $25Non-members will need to provide a copy of your credentials.Membership Status & Fees*Renewing Member - $45Student currently enrolled in an approved ECE program - $25Non-members will need to provide a copy of your credentials.Please upload proof of credentials*Accepted file types: jpg, png, pdf.CheckoutSubtotal $ 0.00 CAD Tax $ 0.00 CAD HST # 97784 9307 RT0001Total $ 0.00 CAD Payment Method*Credit CardCheque/Money Ordere-TransferCredit Card* American ExpressMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Unique IDEmailThis field is for validation purposes and should be left unchanged. Enter your email below to receive updates Enter your email below to receive updates* NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.