|
KAPE Application
Kentucky Association of Professional Educators
Membership Application
Please print this page and fax or mail it to:
KAPE - PO Box 24506 - Lexington, KY 40524-4506
Today's Date_______ Your Birthday __________
Name____________________________________
Address__________________________________
City/State_________________Zip_____________
Home Phone___________Social Security_______
Email ___________@______________________
School______________County/District__________
Position__________Subject_________Grade___
Membership:
Check One:
___New ___Renewal
Dues:
Effective July 1, 2008
Check One:
-
To apply and pay via
PayPal, please click here
-
By check/payroll deduction where available:
_____Individual - $150
_____Couple - $250
_____Students - $25
- By credit card: (Includes $5.00 processing)
_____Individual - $155
_____Couple - $255
- By 3-Monthly Installments (Not available by Credit Card):
(Includes $5.00 Processing)
_____Individual - $155 ($51.67/month)
_____Couple $255 ($85.00/month) Checks/money orders only
(All of the above includes liability insurance)
- Association Affiliation for friends of KAPE:
_____$25 (does not include liability insurance)
Automatic Payroll authorization is available in: Augusta Indep.,
Ballard,
Carlisle, Estill, Fayette, Fleming, Greenup, Harlan, Harlan Indep.,
Henderson, Hickman, Hopkins, Jackson, Jessamine, Lawrence, Lewis,
Ludlow
Indep., Madison, Mercer, Montgomery, Monticello Indep., Oldham,
Paris
Indep., Raceland Indep., Robertson, Rockcastle, Rowan, Russell,
Somerset
Indep., Wayne, Whitley.
Please check any association activities in which you would be willing to participate:
___ Association Leadership
___ Legislature Activities
___ Membership Recruiting
___ Public Relations
Recommended by: __________________
Enclose Check Of $__________
Circle One:
Credit Card: MC Visa Discover Expires____
Credit Card #______________________________
Name on Card____________________________
Authorized Signature________________________________
Send to:
KAPE
PO Box 24506
Lexington, KY 40524-4506
Fax-859-971-0688
888-438-7179
Website: kentuckyteachers.org
E-mail: INFO@KENTUCKYTEACHERS.ORG
Contact the office for additional information
|
|
