NATIONAL CHILD & ADULT CARE FOOD PROGRAM FORUM
APPLICATION/RENEWAL FORM
(Print and send in)

The membership year begins October 1 and runs through September 30 (the federal fiscal year)Membership dues are bases on sponsor size. Non-voting memberships are accepted from individuals who wish to support the CACFP.

Organization Name:
Address:
City:                                              State:                   Zip:
Representative's Name:
Phone: (     )                             Fax: (     )                             Date:
Number of Homes:              Number of Centers:             Head Start?     Yes     No


Check Your Level (if sponsorship has providers and centers choose the category that reflects the largest portion of your program)

     1 - 50 providers, or 1 center                                     $35.00
     51 - 150 providers, or 2 - 5 centers                            $50.00
     151 - 500 providers, or 6 - 10 centers                         $75.00
     501 - 1000 providers, or 11 - 15 centers                      $100.00
     1001 - 2500 providers, or 16 - 20 centers                    $200.00
     2500 and over providers, or 21 and over centers         $300.00
     Individual non-voting member                                   $25.00


Please make checks payable to:
National CACFP Forum
123 E. Powell Blvd.
Ste 300
Gresham, OR, 97030