Members from Anchorage, Bethel, Copper River Basin, Dillingham,Fairbanks,

Juneau,Kenai Peninsula,Mat-Su, Nome/Bering Straits

P.O. Box 672069, Chugiak, AK. 99567-2069 Ph: 907-688-0163 Fax: 907-688-1078

2015Membership Application/Renewal

Please see the definitions of “Program Member”, “Support Member” and “Friend of CACs Member”.

Yes, I wish to be a member of the Alaska Children’s Alliance/NCAstate Chapter as a Program Member. My dues of $100 are enclosed.

Yes, I wish to be a member of the Alaska Children’s Alliance/NCA state Chapter as a Support Member. My dues of $75 are enclosed

Yes, I wish to be a member of the Alaska Children’s Alliance/NCAstate Chapter as a Friend of CACs. My dues of $50 are enclosed

______

Your Name:

Title:

Agency or Group you represent:

If not a CAC, are you a member of your community’s CPT or MDT? YesNo

Mailing Address:

Community and Zip code:

E-mail address:

Website (if any):

Phone: Fax:

Alaska Children's Alliance Membership Definitions

Program Member:A program which meets criteria for and is a dues paying Member of the National Children’s Alliance will be eligible to become a member of the ACA. The program that meets these criteria will have their Director or designee participate in the ACA, as a Board member. Each participating Board member will get one vote.

Support Member:Any MDT or developing CAC. It is expected that they will show their support and commitment to the CAC movement and the ACA mission, and their willingness to improve the response to child abuse in Alaska. Emerging members are a representative of a developing team or center that does not meet criteria for program membership. Individual leadership in MDTs or developing CACs will determine who will represent their team as a Board member. A Support Member should become a Program Member within two years, or will default to Friend status. Each team will get one vote each.

Friend of CACs:A CPT member or individual in a leadership role of a MDT or emerging CAC that supports the ACA Mission, and does not fit in the Program or Support Member categories. This person will be expected to show their support and commitment to the CAC/MDT/CPT movement and their willingness to improve the response to child abuse in Alaska. This category of membership will not have a vote, unless they are appointed by the Board, as a voting Board Member.Non-voting members will have no fiduciary responsibility.