Application for Membership
If you
or your organization are not a KCMLIN member, you can immediately begin
receiving membership rates to workshops by joining today!! Please
fill out the application information below and
send through the courier, fax or mail.
Individual Membership is $25.00/year
Name:
___________________________________________________________________
Address:
_________________________________________________________________
City: _____________________________ State: __________ Zip:
____________________
Library/Organization:
________________________________________________________
Phone:
___________________________________________________________________
Fax:
_____________________________________________________________________
E-mail:
___________________________________________________________________
Charge Card Information:
_____ Visa _____ American Express _____
MasterCard _____ Discover
Credit Card Number: ________________________ Security Code:
___________________
Expiration Date: ___________________ Signature:
________________________________
Mail to: KCMLIN
15624 E. US Highway 24
Independence, MO 64050
Fax: 816-461-0966