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      -- Secure KANAAE Household Discount Application --
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      Secure KANAAE Household Discount Application


      After submitting the secure membership application below you will receive a confirmation page and receipt of your pending application. Your application will be processed immediately and your credit card will not be charged until your application is approved.

      This page is for married members joining or renewing KANAAE professional membership at a special household discount rate.  For all other new members and renewals, please visit the KANAAE join page.

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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: Invalid Input
      Last Name:
      		 Invalid Input * This Field is required
      Preferred Email:
      		 Invalid Input * This Field is required
      Preferred Email Type:
      		 Invalid Input * This Field is required
      Alternate Email: Invalid Input
      Phone Number:
      		 Invalid Input * This Field is required    Invalid Input      format: xxx-xxx-xxxx
      Alternate Phone Number: Invalid Input     Invalid Input      format: xxx-xxx-xxxx
      Mailing Address:
      		 Invalid Input * This Field is required
      Mailing Address Apt/Suite: Invalid Input
      City:
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      State:
      		 Invalid Input * This Field is required
      Zip Code:
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      Birth Date: Invalid InputInvalid InputInvalid Input * This Field is required
      Monthly Newsletter: Invalid Input * This Field is required
      SPOUSE 1 SCHOOL INFO:
      School Name: Invalid Input * This Field is required
      School Type: Invalid Input * This Field is required      Other:
      School District: Invalid Input * This Field is required include USD#
      School County: Invalid Input * This Field is required
      School State:
      		 Kansas * Visit www.aaeteachers.org to join our national partner if you teach in a state other than Kansas.
      Position: Invalid Input * This Field is required
      Grades: Invalid Input * This Field is required
      Subjects: Invalid Input * This Field is required
      SPOUSE 2 CONTACT INFO:
      First Name:
      		 Invalid Input * This Field is required
      Middle Name: Invalid Input
      Last Name:
      		 Invalid Input * This Field is required
      Preferred Email:
      		 Invalid Input * This Field is required
      Preferred Email Type:
      		 Invalid Input * This Field is required
      Alternate Email: Invalid Input
      Phone Number:
      		 Invalid Input * This Field is required    Invalid Input      format: xxx-xxx-xxxx
      Alternate Phone Number: Invalid Input     Invalid Input      format: xxx-xxx-xxxx
      Invalid Input * Check this box to confirm mailing address is the the same for both members
      Birth Date: Invalid InputInvalid InputInvalid Input * This Field is required
      Monthly Newsletter: Invalid Input * This Field is required
      SPOUSE 2 SCHOOL INFO:
      School Name: Invalid Input * This Field is required
      School Type: Invalid Input * This Field is required      Other:
      School District: Invalid Input * This Field is required include USD#
      School County: Invalid Input * This Field is required
      School State:
      		 Kansas * Visit www.aaeteachers.org to join our national partner if you teach in a state other than Kansas.
      Position: Invalid Input * This Field is required
      Grades: Invalid Input * This Field is required
      Subjects: Invalid Input * This Field is required
      PAYMENT INFO:
      Card Type:
      		 Invalid Input * This Field is required
      Name on Card:
      		 Invalid Input * This Field is required
      Credit Card Number:
      		 Invalid Input * This Field is required
      Card Expiration Date:
      		 Invalid InputInvalid Input * This Field is required
      OTHER INFO:
      Who referred you to or how
      did you hear about KANAAE?      		 Invalid Input
      First Year Teachers: Invalid Input
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