Membership Signup

Membership Application
Name of individual or entity registered as an Approved Provider.
Please provide the name of the primary contact person for the Approved Provider.
Services Operated by the Approved Provider
How many Services are operated by the Approved Provider?
I/ We wish to apply for Membership to Network of Community Activities in the following category:
Type of Membership
For more information please consult our Membership Info Pack.
Service Details
If the Provider operates multiple Services, please list all Services separated by a semicolon.
For Providers operating more than one Service, our membership officer will liaise with you to collect contact information for each Service.
Service Information
Service Type
Select all that apply. For Providers with multiple Services, our membership officer will liaise with you directly to discuss your the type of each individual Service.
Provider Type*

If you are operating a service, please complete the following:
For Providers with multiple Services, please list the year that the first Service opened, or your closest approximation.
Is your Service registered to receive Child Care Subsidy (CCS)?
Approved Places
This field is for validation purposes and should be left unchanged.