Apply Online - Full Membership JAVASCRIPT_ERROR_MESSAGE JAVASCRIPT_ERROR_MESSAGE Agency Information Organization Company * {{ company.company_name }} Existing Office {{ location.location_name}} {{ location['1_address_1']}} Create New Office URL Email Telephone Fax Address line 1 Address line 2 City Province Please Select Alberta British Columbia Manitoba New Brunswick Newfoundland/Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut District of Columbia Delaware Florida Micronesia Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Outside U.S./Canada Postal Code Country Please Select Canada Mexico United States Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Congo Congo, The Democratic Republic of the Cote d'Ivoire - Really Ivory Coast Djibouti Egypt Equatorial Guinea Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea Bissau Kenya Lesotho Liberia Libyan Arab Jamahiriya Madagascar Malawi Mali Mauritania Mauritius Morocco Mozambique Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal Seychelles Sierra Leone Somalia South Africa Sudan Swaziland Tanzania, United Republic of Togo Tunisia Uganda Zambia Zimbabwe Afghanistan Armenia Azerbaijan Bangladesh Bhutan Brunei Darussalam Cambodia China East Timor Georgia India Indonesia Japan Kazakhstan Korea, Democratic People's Republic Korea, Republic of Kyrgyzstan Lao People's Democratic Republic Malaysia Maldives Mongolia Myanmar Nepal Philippines Russian Federation Singapore Sri Lanka Taiwan Tajikistan Thailand Turkmenistan Uzbekistan Viet Nam Australia Fiji Kiribati Marshall Islands Micronesia, Federated States of Nauru New Caledoni New Zealand Palau Papua New Guinea Samoa Solomon Islands Tonga Tuvalu Vanuatu Antigua and Barbuda Aruba Bahamas Barbados Belize Bermuda British Virgin Islands Costa Rica Cuba Dominica Dominican Republic El Salvador Grenada Guatemala Haiti Honduras Jamaica Nicaragua Panama Puerto Rico Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Trinidad and Tobago Albania Andorra Austria Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark Estonia Finland France Germany Great Britain Greece Hungary Iceland Ireland Italy Latvia Liechtenstein Lithuania Luxembourg Macedonia, Former Yugoslav Republic of Malta Moldova, Republic of Monaco Netherlands Norway Poland Portugal Romania San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland Ukraine Bahrain Cyprus Iran, Islamic Republic of Iraq Israel Jordan Kuwait Lebanon Oman Pakistan Qatar Saudi Arabia Syrian Arab Republic Turkey United Arab Emirates Yemen Argentina Bolivia Brazil Chile Columbia Curacao Ecuador French Guiana Guyana Paraguay Peru Suriname Uruguay Venezuela Primary Organization Contact First name * Middle name Last name * Primary Phone Please Select Home Work Cell E-mail * Position Account Password * Password must be a minimum of 6 characters long and contain at least 1 uppercase letter, 1 lowercase letter and 1 number. Password Confirm password Date of First License For Profit * Yes No Accept Student field Placements * Yes No # of Programs * Programs Operating In Ministry Region(s): * All North East West Central/Toronto How did you find out about us? Ontario Care Collective Member CAS Ministry Other (please explain) * (Please Provide Agency Name) * References Required for agencies new to Ontario Care Collective, former members need not complete Reference 1 First name Last name Primary Phone Please Select Home Work Cell Fax number E-mail Position Relationship Company/Organization Reference 2 First name Last name Primary Phone Please Select Home Work Cell Fax number E-mail Position Relationship Company/Organization Referral Agencies Currently Using Your Services Required for agencies NEW to Ontario Care Collective, former members need not complete Agency 1 Primary Organization Contact First name Last name Primary Phone Please Select Home Work Cell E-mail Position City Agency 2 First name Last name Primary Phone Please Select Home Work Cell E-mail Position City Agency 3 First name Last name Primary Phone Please Select Home Work Cell E-mail Position City $ 5500.00 - Full Membership – 81+ clients Full Voting Membership (client refers to all individuals receiving service from your organization) $ 4500.00 - Full Membership – 31 – 80 clients Full Voting Membership (client refers to all individuals receiving service from your organization) $ 3500.00 - Full Membership – 11 - 30 clients Full Voting Membership (client refers to all individuals receiving service from your organization) $ 2500.00 - Full Membership - 10 or fewer clients Full Voting Membership (client refers to all individuals receiving service from your organization) $ 2500.00 - Full Membership - New Licensee (1st year) Full Voting Membership for one year only $ 2500.00 - Associate Member Fee (non-voting) - New License Applicant Associate Membership (non-voting) for those organizations or individuals who are not licensed and who share Ontario Care Collective’s dedication to children, youth and adults receiving service. $ 1000.00 - Associate Member Fee (non-voting) - Placing Agency/Partner Assoc Associate Membership (non-voting) for those organizations or individuals who are not licensed and who share Ontario Care Collective’s dedication to children, youth and adults receiving service. $ 1000.00 - Associate Member Fee (non-voting) - Vendor Serving the Sector Associate Membership (non-voting) for those organizations or individuals who are not licensed and who share Ontario Care Collective’s dedication to children, youth and adults receiving service. $ 75.00 - Associate Membership (non-voting) - Student Associate Membership (non-voting) for those organizations or individuals who are not licensed and who share Ontario Care Collective’s dedication to children, youth and adults receiving service. 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