print and mail membership form
TRANSCRIPT
A.B.A.T.E. of Kansas, Inc. Membership ApplicationReturn Application to A.B.A.T.E. of Kansas, Inc.
P.O. Box 102, Perry, KS 66073
Date __________________
Dist# _________________
q New Member $30 q Couple $50 q Renewal Ind/Cpl Mbr#_____________________________ q Life Member $300 q Change of Address q Change of District q Registered Voter
Please Print Clearly
Full Name _____________________________________________________________________________________________
Full Name _____________________________________________________________________________________________
Address / Apt#______________________________________________________ County _____________________________
City _______________________________________________ State ______________________ Zip __________________
E-Mail ___________________________________________________________ Phone______________________________
Newsletter: q Mail q E-Mail Referred By _______________________________________________________________
Applicant’s Signature _____________________________________________________________________________________
Payment Type: q Cash q Check Amount $____________ Check #___________ Revised April 2017
A.B
.A.T
.E. o
f Kan
sas,
Inc.
P.O
. Box
102
, Per
ry, K
S 66
073
(785
) 597
-514
0 (
800)
657
-576
3
Date ______________________________Exp ______________________________
q R
enew
al q
New
q C
oupl
e q
Life
q B
usin
ess B
ronz
e q
Bus
ines
s Silv
er
q B
usin
ess G
old
App
lican
t ___
____
____
____
____
____
____
____
____
Rece
ived
By _
____
____
____
____
____
____
____
____
Rece
ipt f
or a
pplic
ant
Fees
are
not
tax
dedu
ctib
le.
q Business Bronze $60 q Business Silver $150 q Business Gold $350q Business Renewal
Business Name______________________________ Point of Contact_______________________________
Place remainder of Business info on reverse side of form.
Business Membership Benefits Outside of all other Member Benefits.
Business Membership Bronze: Small advertisement listing in newsletter.
Business Membership Silver: Small advertisement in newsletter, small listing in Rally Flier, and listing on both A.B.A.T.E. Facebook page and website.
Business Membership Gold: Business Card advertisement in newsletter, small listing in Rally Flier, and listing on both A.B.A.T.E. Facebook page and website.
Note: Small listing will consist of Business Name, Address, Phone, Point of Contact and if they support A.B.A.T.E. members with a discount or other perk.
Couples Membership must be same household.