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*User ID

*Primary First name

*Primary Last name

*Center Name / Organization

*Phone Number

*Accept Text

YES

*Secondary Email Address

*Secondary Contact First Name

*Secondary Contact Last Name

*Secondary Cell

*2nd Accept Text

Yes

*Preferred Mailing Address

*Physical City of Center

*Physical State of Center

*Physical Zip of Center

*Physical Parish of Center

*Website

*License Number

*Licensure Capacity

*Total # of Employees

*Would you like to be a key legislative contact?

Yes

*Referred By

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Childcare Association of Louisiana is statewide, non-profit, professional membership organization that advocates on behalf of the early childhood education profession.

Call

(225) 242-9470

membership@childcarelouisiana.org