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KSDC Membership Application Download or print this application. After completing it, mail it with your check or purchase order # to the address at the bottom of this page. Welcome to KSDC! ___$40 AGENCY MEMBERSHIP (Service centers, interlocals, higher education departments, or district central offices.) Membership includes:
___$15 FOR EACH BUILDING MEMBERSHIP ... in combination with agency membership only and submitted with the Agency (District) membership (Individual buildings with separate street addresses such as high school, middle school, or grade school.) Agency members may add additional buildings to their membership for $15 per building if submitted with agency membership. (Maximum of $190 per agency for 10 buildings or more. If more than 10 buildings are listed, no additional charges will be incurred beyond $190.) Please complete a membership application for each building. Membership includes:
___$40 BUILDING MEMBERSHIP (for a building joining separately) Membership includes:
___$15 INDIVIDUAL MEMBERSHIP (A membership for one individual.) Membership includes:
Name __________________________________________________ Title/Position _____________________________________________ Name of District/Agency/Building ______________________________ Day Phone _______________________________________________ Evening Phone ____________________________________________ Mailing Address ___________________________________________ City __________________________________Zip _______________ E-Mail Address ____________________________________________ I belong to NSDC: YES NO Is this a renewal of your KSDC membership? YES NO New Member? YES NO If a new member, I was referred by _____________________________ Mail completed applications to: Tom Jerome, KSDC Treasurer, Box 616, Eudora, KS 66025 The KSDC membership year begins October 1 and ends September 30. |
