Join CVECA Annual Dues are $31.00 per family ($30 membership + $1 processing fee) You are only a few steps away from your new CVECA membership! Please fill out this form and we will process your application immediately. Your Contact Information:Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country PhoneEmail* Your Family Information:Number Of Children*Names and ages of children*Please tell us your children's names & birthdays. (e.g. John Smith - 01/01/2011)Spouse's NameCVECA Information:Please note: Playgroups are not open to the public and are only available to paid CVECA members. Playgroups are an included benefit of your paid CVECA membership. To be placed in a playgroup you must join CVECA for $30/yr + $1 processing fee by completing this form.Are you interested in joining a playgroup?*Yes, please contact me regarding playgroupsNo, I am not interested in playgroups at this timeMy preferred playgroup meeting times are:* Monday Morning Monday Afternoon Monday Early Evening Tuesday Morning Tuesday Afternoon Tuesday Early Evening Wednesday Morning Wednesday Afternoon Wednesday Early Evening Thursday Morning Thursday Afternoon Thursday Early Evening Friday Morning Friday Afternoon Friday Early Evening Weekend Morning Weekend Afternoon Please pick at least three (3) choices for meeting times. Exact playgroup times will be determined by each group.Any other playgroup questions, comments or concerns?We need volunteers!Yes, I'd like to volunteerNo, I'm not quite ready to volunteer yetCan you help us make CVECA even better? CVECA is entirely run by volunteers and we're always looking for people to help us run our organization. I would like to help with the following activities: Play Groups Fund Raising Weekly Events Kinds Parties Philanthropy Publicity Website Membership Sunshine Committee How did you hear about CVECA?Any thing else you'd like to tell us?Payment Information:Annual CVECA Membership* Price: $30.00 $30 Membership Dues + $1 Processing FeeCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Terms & Conditions* I have read and agree to the conditions listed below I understand that my child(ren) must be accompanied by an adult at all activities and that adult is responsible for the behavior and safety of my child. In case of an accident, neither CVECA, its board members, nor its membership shall be held responsible. I consent to the use of any photographs taken of my minor child (ren) at all CVECA events for utilization in CVECA promotional materials. Also, I understand that children and/or parents should not attend any CVECA events if they are exhibiting any signs of a contagious illness, including but not limited to: coughing, sneezing, runny nose (mucous clear, but profuse or discolored); fever or illness within the past 24 hours; unusual fatigue or irritability; vomiting or diarrhea; inflamed mouth and throat. PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.