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 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Unique IDPhoneThis field is for validation purposes and should be left unchanged. Enter your email below to receive updates Enter your email below to receive updates* PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.