OCHAP Application Form

Please print this form, fill in information, and mail to OCHAP.

Mailing Address:

Ottawa-Carleton Headstart Association for Preschools
c/o Hawthorne Meadows Nursery School, Inc.
2244 Russell Road
Ottawa, Ontario K1G 1B3

Name:_____________________________________________
Title:______________________________________________
Organization:________________________________________
Address:___________________________________________
City:___________ Province:_______ Postal Code :__________
Phone: (_____)______________ Fax: (_____) _____________
E-mail: ____________________________________________
Brief Description of Your Organization: ____________________
__________________________________________________
__________________________________________________
__________________________________________________

Membership Fees:

• Full Membership: $ 50.00 per year
  (Headstart Programs)
• Associate Membership: $ 40.00 per year
  (Child Care Centres and Social Service Providers)
• Individual Membership: $ 20.00 per year

Membership Interest:

( ) (We) wish to become a member of the Ottawa Carleton
Headstart Association for Preschools. Please find enclosed my
contribution of $______

( ) I (We) wish to learn more about becoming an OCHAP
member. Please call us to arrange a meeting.

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