P.O.

BOX 31867 Grand Cayman KY1- 1208 ~CAYMAN ISLANDS Tel: 939-7426 / 916-6367 Working Together Building a Strong Foundation

MEMBERSHIP APPLICATION
FULL NAME BIRTHDATE (day/month) PHYSICAL & MAILING ADDRESS PHONE NUMBERS FAX or EMAIL CONTACT NAME OF SCHOOL OR PRESENT EMPLOYER: OCCUPATION & POSITION: QUALIFICATIONS / TRAINING EARLY CHILDHOOD EXPERIENCE SPECIAL SKILLS HOBBIES REFERENCE #1 REFERENCE #2 OTHER RELEVANT INFORMATION
I certify that the above information is accurate, and by signing this form, I am subscribing to and agree to the terms and conditions of the Articles and Memorandum of Association of the Cayman Islands Early Childhood Association that has been made available to me or my organization, and any amendments the CIECA may make from time to time, which is incorporated herein.

HOUSE # P.O. BOX CELL: FAX:

STREET POSTAL CODE: WORK: EMAIL:

DISTRICT ISLAND: HOME:

NAME: NAME:

PH. PH.

ADD. ADD.

OFFICIAL USE ONLY

Dues Paid: ________ Membership Card Issued: _____ Articles & Memorandum of Association supplied to: _____________________________

Signature of Applicant: __________________________ Date: _________________

Executive Committee 2010-2011:

President: Mrs. R. Jefferson 939-7426 pecsltd@yahoo.com Vice President: Mrs. S. Haylock 916-6367 sewlc@candw.ky Secretary: Mrs. R. Barnes 925-8930 rbarnes@pps.edu.ky Treasurer: Mr. E. Todd 321-5867 ETodd@jghs.edu.ky Asst. Secretary: Ms. D. Senior 928-5755 diannsenior85@yahoo.com Asst. Treasurer: Mrs. C. Bradshaw-Miller 326-8075 cbradshawmiller@yahoo.com P.R.O. Ms. L. Fraser 938-1866 laurfras@gmail.com

P.O. BOX 31867 Grand Cayman KY1- 1208 ~CAYMAN ISLANDS Tel: 939-7426 / 916-6367 Working Together Building a Strong Foundation

Executive Committee 2010-2011:

President: Mrs. R. Jefferson 939-7426 pecsltd@yahoo.com Vice President: Mrs. S. Haylock 916-6367 sewlc@candw.ky Secretary: Mrs. R. Barnes 925-8930 rbarnes@pps.edu.ky Treasurer: Mr. E. Todd 321-5867 ETodd@jghs.edu.ky Asst. Secretary: Ms. D. Senior 928-5755 diannsenior85@yahoo.com Asst. Treasurer: Mrs. C. Bradshaw-Miller 326-8075 cbradshawmiller@yahoo.com P.R.O. Ms. L. Fraser 938-1866 laurfras@gmail.com