2006-2007 school year
Membership Application Form
If you do not want part or all of this information included in our Membership Directory, please clearly indicate that. Also, please be assured that the NCHA Membership Directory will never be distributed electronically and is for member-use only.
Parent’s/Guardian’s/Care Giver’s Name _______________________________________
Cell phone ______________________________________________________________
Email address ____________________________________________________________
Other Parent’s Name ______________________________________________________
Cell phone ______________________________________________________________
Email address ____________________________________________________________
Family’s home phone number _______________________________________________
Family’s street address _____________________________________________________
City, State, Zip code _______________________________________________________
Children’s names, birthdays (please include year of birth, not age), and email addresses
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Please submit this application along with $12.00 to the NCHA treasurer. Please make check payable to: NCHA.