City: State: Zip:
Home Number:
Home Email:
Employer Supervisor:
Employer Address:
City: State: Zip:
Work Phone:
Work Fax:
Work Email:
Educational Level:
If you selected 'Other' please specify:


***CEU hours and report form must be mailed in with the renewal. If for some reason, you did not complete 20 hours of continuing education, please look at the “Alternatives to Workshops or conferences” and you may be able to complete the CEU hours that way. You have a one year grace period to complete the unearned 20 hours plus the 20 hours for the current year. Members that are utilizing their membership and certification for Medicaid billing will need to be current for their names to be forwarded to the appropriate parties.

  Membership and/or Certification Renewal:
Membership Only Renewal Fee:
Certification Renewal and Membership renewal Fee:
Student Membership Fee
*Late Fee:
$15 * Postmarked after July 31, 2014

Committee Involvement & Selection:

We have several committees that continually need new members. Please indicate with a check any committee that you would be interested in joining.

Advocacy Family Week Membership Newsletter Events/Conferences Special Needs

Membership Benefits:

Do you want to receive the Oklahoma Institute for Child Advocacy’s Children’s
Information Network (CIN) via email?

Yes If so, list email preference

The CIN is a statewide network of child & youth advocates working together to make a positive impact on the policies and budgets that affect children, youth and families of Oklahoma. The CIN offers three major services: Weekly Monitoring Report, Briefings/Consultation & Training and Publications. Each week during the legislative session, from February through May, subscribers receive a summary of bills that have a significant bearing on children, youth and families www.oica.org

If the Membership Directory is updated do you object to any information being listed?
If you DO, please note with a check:
NO INFO. Home/Work Home Only Work Only

OFRC Certification:

If you are currently not certified, contact Brenda Butchee to apply. Certification packets are $10.00.

__ Certified Child & Parenting Assistant (C.C.P.A.)
__ Certified Child & Parenting Practitioner (C.C.P.P.)
__ Certified Child & Parenting Specialist (C.C.P.S.)

Organizational Memberships:

Organizational members can extend a FREE membership to their employees that they want to include as members of OFRC. The membership also includes the OFRC newsletter and the Children’s Information Network (CIN). If your agency purchases a membership they need to include a Membership Form on EACH employee that is to be
included as an OFRC member.


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