Membership Plan: 
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New Member or Renewal: 
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If you are only trying to update your contact or payment information, use the Update Form. |
SPOUSE 1 CONTACT INFO: |
First Name:
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Middle Name: |
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Last Name:
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Preferred Email:
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Preferred Email Type:
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Alternate Email: |
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Phone Number:
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Alternate Phone Number: |
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Mailing Address:
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Mailing Address Apt/Suite: |
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City:
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State:
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Zip Code:
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Birth Date: |
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Monthly Newsletter: |
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SPOUSE 1 SCHOOL INFO:
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School Name: |
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School Type: |
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School District: |
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School County: |
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School State:
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Kansas  |
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Position: |
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Grades: |
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Subjects: |
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SPOUSE 2 CONTACT INFO: |
First Name:
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Middle Name: |
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Last Name:
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Preferred Email:
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Preferred Email Type:
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Alternate Email: |
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Phone Number:
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Alternate Phone Number: |
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Birth Date: |
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Monthly Newsletter: |
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SPOUSE 2 SCHOOL INFO:
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School Name: |
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School Type: |
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School District: |
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School County: |
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School State:
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Kansas  |
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Position: |
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Grades: |
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Subjects: |
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PAYMENT INFO: |
Card Type:
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Name on Card:
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Credit Card Number:
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Card Expiration Date:
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OTHER INFO: |
Who referred you to or how did you hear about KANAAE? |
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First Year Teachers: |
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Interested in getting more involved? check all that apply |
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