Membership Form Please fill in this form if you are interested in becoming a member of the Collaborative Action for Childcare. Membership Registration FormFirst Name Last Name Email I am a/an Organization Individual Government RepresentativeOrganizational Details Organization's Name Organization's Website Organization's AddressPhysical Address City/Town Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweIndividual Details Your Physical AddressAddress City Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweOrganizational/Individual's Geographic Focus Kenya Africa GlobalKenyan Areas of Focus Type of Organization or Association International NGO Donor/Funder Private Sector Small Local Organization/ Startups NGO/CSO/Academic Institution/Research Institution/Advocacy Institution OtherOther Organization Type What age of children does your work focus on? 0-3 years 4-5 years 5-8 years 9 years & above What thematic area/s under childcare do you/your organization focus on? Health Nutrition Safety & Security Responsive Caregiving Women Economic Empowerment Workforce Development Special Needs and Inclusion Child Well-being Women Rights Advocacy OtherOther area of thematic focus What is your interest in becoming a member of Collaborative Action for Childcare? Have opportunities to support and work alongside governments to develop and achieve their objectives. Be able to connect with colleagues within an active and diverse network of childcare professionals in learning and networking spaces. Have the opportunity to be part of various engagements with a variety of stakeholders and lobby for a favorable childcare environment in the region. Have access to various childcare learning and sharing forums nationally and internationally, while providing expert knowledge and practical experiences of childcare Enjoy the freedom to use the Collaborative Action for Childcare logo in any of their publications and or meetings. Enjoy subsidized rates in any conference, workshop, training or event organized by Uthabiti Africa and potentially any member of the Collaborative as may be agreed from time to time Be able to jointly fundraise for and implement activities related to childcare at county, national, regional and global level Be a member of the technical working groups and have an opportunity to (co-) host CAC eventsHow did you hear about the Collaborative Action for Childcare? Website Referral from another member Social Media Newsletter Event OtherOrganization Staff Contact Information: Please list all staff members of your Organization/Association that would like to be involved in the coalition and added to the main CAC list serve. Please click on the (+) plus button next to the email address field to include all interested staff members, including those already on the list serve, to ensure we have a complete and accurate list.Which Technical Working Group under the Collaborative, would you/your organization be interested in joining? Childcare Legal, Policy and Regulatory Reform Technical Working Group (PRR-TWG) Women in Childcare Technical Working Group (WiC-TWG) Special Needs and Inclusion Technical Working Group (SN & I-TWG) Maternal, Child Health Technical Working Group (MCH-TWG) OtherChildcare Legal, Policy and Regulatory Reforms (PRR) Technical Working Group Please list all staff members of your organization/association that would like to be added to the Childcare Policy and Regulatory Reforms (PRR) Technical Working Group list serve. Please click on the (+) plus button next to the email address field to include all interested staff members, including those already involved in the Working Group.Women in Childcare (WiC) Technical Working Group Please list all staff members of your organization/association that would like to be added to the Women in Childcare (WiC) Technical Working Group list serve. Please click on the (+) plus button next to the email address field to include all interested staff members, including those already involved in the Working Group.Special Needs and Inclusion (SN & I) Technical Working Group Please list all staff members of your organization/association that would like to be added to the Special Needs and Inclusion (SN&I) Technical Working Group list serve. Please click on the (+) plus button next to the email address field to include all interested staff members, including those already involved in the Working Group.Maternal, Child Health (MCH) Technical Working Group Please list all staff members of your organization/association that would like to be added to the Maternal, Child Health (MCH) Technical Working Group list serve. Please click on the (+) plus button next to the email address field to include all interested staff members, including those already involved in the Working Group.Membership Rates Category Annual Subscription UN Agencies, Funder, Development Partners 1500 USD INGOs and Affiliates 1000 USD Corporates 1000 USD Local NGOS, CSO’s, FBO’s, Research Institutions, Academia 500 USD Small Local Entities and Start-ups 200 USD Individuals 100 USD Payment Details Please choose your preferred mode of payment 1. MPESAPayBill Number: 4068527Account Number: Organization's Name/Individual's Name === 2. Bank PayBill NumberBank PayBill Number: 247247Account Number: 0550180560795 === 3. Direct Bank Transfer (incl) InternationalACC Name: Uthabiti Africa Advisory Services LtdBank: Equity BankBranch: WestlandsAccount Number: 0550280558328 (USD)Account Number: 0550180560795 (KES)SWIFT Code: EQBLKENAPayment Verification Details Additional Notes Submit Form