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Membership Enrollment Application

To become a member of Early Learning NH, fill out the form below and pay by credit card, or download the enrollment form and mail it in with your payment to the Early Learning NH office. Note that there are a number of different levels to become a member. Please select the level you desire.

Fields marked with a red asterisk (*) are required.

* First Name:
* Last Name:
* Organization
Position
* Address
* City/Town
* State
* Zip
Home Phone
* Work Phone
* E-mail
Fax
Web Site URL

Basic Membership

Family-based Program - $30.00
Center-based Program - $75.00

ECE Shared Resources Membership

Family-based Program - $15.00 per month
Family-based Program - $144.00 per year (a savings of $36.00 dollars)
Center-based Program - $29.00 per month
Center-based Program - $300.00 per year (a savings of $48.00 dollars)

Seacoast Early Learning Alliance Membership

Family-based and Center-based Programs - $100 per month
Family-based and Center-based Programs - $1200 per year

Please list me in the following category (check all that apply):

Center
Family
School Age Program
Preschool
Non-Profit
For-Profit
Advocate
Elected Official
Kindergarten
Family - Group
Elementary School
Library
State Official
Send information about Conference?
Receive Newsletter
Food Care Program Sponsor
Advocacy Taskforce
Media
Ages Cared For? No. of children served:
Hours Open No. of Staff:
How did you hear about us?
Can other members search for your listing?

Early Learning NH
Two Delta Drive, Concord, NH 03301
Phone: (603) 226-7900   Fax: (603) 226-7290   info@earlylearningnh.org