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Member Registration Form Name: ________________________________________________________________________ Title: ________________________________________________________________________ Organization: __________________________________________________________________ Address: __________________________________________________________________
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__________________________________________________________________ Phone: Home / Cell / Work ________________________________________________ Email: Home / Work
______________________________________________________ Yes, it is okay to include my name and contact information in a NECLP
Directory. I prefer for my information to not be included in the NECLP Directory. Membership dues are $25 annually for professionals, $20 annually for students (with proof). Please make checks payable to: New England Child Life
Professionals Please mail to: New England Child Life Professionals, Inc. c/o Rachel Alley 328
Main Street South
Hadley, MA 01075
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