CT After School Network

collage of three pictures of children - first picture is of a girl sewing, second picture is children on outdoor play gym and third picture is three girls doing craft at table

Connecticut After School Network
Membership Application

Name
Program
Address
City	State Zip Code
Phone	(Home) (Work) (Fax)
Email

Membership Category:

Individual Professional ($60)

Organizational Professional:

3-10 Employees ($150)

11+ Employees ($300)

Supporter:
Silver ($50)

Gold ($100)

Platinum ($250)

Amount enclosed $
I would like to pay now using PayPal™
Please invoice me. I will pay later.

I do not want my name included in a directory for Connecticut After School Network or NAA members.
I do not want my name shared with groups whose service or products are of potential benefit to me.

You can print this form and mail it with your payment to:
Connecticut After School Network, Inc.
12 Melrose Ave.
Branford, CT 06405

With an Organizational Membership please enter the name and email address for each person included in the group membership. (or skip this section)

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If you have membership questions, contact the Network office by phone 203-483-1846 or email info@ctafterschoolnetwork.org